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Abstract: TH-PO400

A New Initiative to Measure the Provincial Rate of Peritoneal Dialysis Related Peritonitis in Ontario

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • McFarlane, Philip, St. Michael's Hospital, Toronto, Ontario, Canada
  • Yeung, Angie, Cancer Care Ontario, Toronto, Ontario, Canada
  • Graham, Janet Lynn, The Ottawa Hospital, Ottawa, Ontario, Canada
  • Ip, Jane, Cancer Care Ontario, Toronto, Ontario, Canada
  • Jain, Arsh, London Health Sciences Center, London, Ontario, Canada
  • Patel, Monisha, Ontario Renal Network, Toronto, Ontario, Canada
  • Nesrallah, Gihad E., The University of Western Ontario, Toronto, Ontario, Canada
Background

Peritonitis is an important complication of peritoneal dialysis (PD), as it is the most common cause of PD technique failure. In April 2016, the Ontario Renal Network (ORN, which funds dialysis in Ontario) launched a provincial quality improvement (QI) initiative with the aim to shift from local monitoring of peritonitis rates to a province-wide standardized tracking system.

The initiative was launched with the objectives of defining a provincial average rate of peritonitis, and an individualized rate for each of the Regional Renal Programs (RRP), comparing provincial rates against the ISPD benchmark of 0.67 cases per annualized patient and sharing provincial data and developing program-level QI plans to help minimize peritonitis risk.

Methods

All 26 RRPs in Ontario collected and reported data from May 2016 – December 2017 using a tracking tool incorporating indicator methodology developed by an expert panel. Reported peritonitis events formed the numerator for the rate calculation, while the denominator was derived from the Ontario Renal Reporting System database (ORRS) to calculate person-time on PD. The peritonitis rate is expressed as number of infections per year at risk, combining patient-time from all PD patients at each RRP.

Results

Over a period of 20 months (May 2016 to December 2017), 888 unique peritonitis cases were reported over a total of 1,426,243 patient days (3908 annualized patients). Program-level peritonitis rates ranged from 0.10 – 0.44 and the provincial average was 0.23 episodes/365 PD catheter-days. Quarterly reports were shared with the programs for data validation, comparison and monitoring purposes. The initiative enabled consistent measurement and reporting of peritonitis that allowed programs to benchmark themselves against their peers, and design local quality improvement plans.

Conclusion

The risk of peritonitis is deemed to be relatively low in Ontario, and consistently below ISPD targets. This initiative has produced a sustainable system of data collection for monitoring the risk of peritonitis, and is part of a larger strategy to ensure that all patients receiving dialysis therapy experience as few complications as possible for safe and individualized dialysis access.

Funding

  • Government Support - Non-U.S.