too stuck on trees.
but now you're invested,
so I'm left pretending,
its all I can see....(lyrics)
David Mamet wittily defines ambivalence as "watching your mother-in-law drive over a cliff in your new Cadillac".
My ambivalence is currently focused on the PEAK study report that has been heavily publicized in the media.
PEAK points to improvement in 1-year mortality in dialysis patients.
Of course, we should celebrate this, but I am skeptical also. PEAK's message to the world (and that of Kidney Care Partners, the lobbying coalition behind it) is that things are improving for dialysis patients and that current approaches to care seem to be working. If this is truly so then why not have the work peer reviewed and formally published.
Recall that PEAK or Performance Excellence and Accountability in Kidney Care "is a voluntary quality improvement campaign undertaken by Kidney Care Partners and the kidney community to reduce mortality among first-year dialysis patients on a national level." PEAK is sponsored by Kidney Care Partners a Washington DC coalition ("a coalition of patient advocates, dialysis professionals, care providers and manufacturers")
The PEAK project's report is available online here.
Here is a description of the PEAK initiative from a recent article:
"As part of the campaign, KCP worked with Quality Partners of Rhode Island (now Heathcentric Advisors) to convene a series of expert panels to focus on clinical as well as patient and family engagement "best practices" that, if implemented consistently, could help improve survival rates. Areas of focus included reducing catheter use in favor of arteriovenous fistulas, improving cardiovascular outcomes, managing nutrition and inflammation, handling anemia, and optimizing dialysis, along with screening for depression, educating patients, and providing social support.
To monitor the kidney care community's efforts to improve first-year survival rates, KCP partnered with researchers at Brown University who analyzed government data sets that include information on patient deaths. Researchers from within the kidney care community worked with Brown researchers on a technical advisory panel to help interpret the data."
The final report was prepared by Drs. Vincent Mor and Shailender Swaminathan from Brown University.
“The reduction in first-year mortality represents a significant quality achievement," said Dr. Mor, the Florence Pirce Grant professor of community health in the public health program of the Brown University School of Medicine. “A reduction of 13.6 percent in first-year mortality and 25 percent in 90-day mortality is quite substantial. It's impressive that the kidney community launched this initiative voluntarily and independently. They didn't depend on government to do it for them."
Bottom-line: it's fantastic that 1-year mortality is improving. And, methodologically the researchers probably got it right. My ambivalence is around claims by KCP and PEAK that their initiatives made the difference. They might have; but, the PEAK investigators need to present evidence in the scientific literature to support their claims before making self-serving statements in the press.
