what did we learn from the 1989 dallas morbidity and mortality meeting?
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What did we learn from the 1989 Dallas Morbidity and Mortality Meeting?. Alan R. Hull, MD. A teaching hospital of Harvard Medical School. 3 Questions proposed for the Dallas Meeting. Is the mortality rate in the U.S. actually higher than other “industrialized” countries? - PowerPoint PPT PresentationTRANSCRIPT
What did we learn from the 1989 Dallas Morbidity and Mortality Meeting?
Alan R. Hull, MD
A teaching hospital of
Harvard Medical School
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
3 Questions proposed for the Dallas Meeting
Is the mortality rate in the U.S. actually higher than other “industrialized” countries?
Has the mortality rate in the U.S. been increasing?
Can the differences between the countries be accounted for by the prescription and delivery of dialysis or the demographics/incidence rate of the patients?
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
The Requested Format for the Dallas Meeting Yearly acceptance rate
(Incidence) Prevalence rate for the calendar
year GROSS MORTALITY
– Definition: deaths during the calendar year over the mid year census
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
1987 – 88 Comparison of RegistriesRegistry Incidence
*Prevalenc
e*Transplant
*Gross
Mortality (%)
Canada 71 186 32 18.9
FRG 76 320 27 10
France 56 254 24 7.3
Japan 137 671 <2 8.8
U.S(Current)
151 (360)
403 (1200)
37 23.4
Australia 48 152 25 13.5
*PMP/Y*PMP/Y
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
Summary of the Dallas Meeting The U.S. did have a higher
mortality rate– Higher incidence rate
Mortality rate was increasing over the previous 4 years (1984-88)
Multiple theories– Most prevalent theory = prescription
and delivery of dialysis
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
Contemporary Provocations and Final 3 Questions (1) Why do you support the current
thrice weekly in-center hemodialysis system for your patients?
The Bevan Story– Is it possible that the dialysis providers
are following Bevan’s lead and the “gold” is the Medical Director’s fee?
– A true story
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
Contemporary Provocations and Final 3 Questions (2) Is it possible, although you are
the patient’s physician, that you are subjecting them to a treatment that you would not accept yourself - nor have your immediate family undertake?
A teaching hospital A teaching hospital
of of Harvard Medical Harvard Medical
SchoolSchool
Provocation: Therapies and Outcomes Possible Therapies
– CAPD– CCPD– Conventional In
Center– Nocturnal In Center– Conventional HHD– Nocturnal HHD– Short Daily HHD– Transplant
Living Cadaveric
– Palliative
Therapies Stratified by Outcomes– Transplantation– Nocturnal HHD– Nocturnal In-center
and Short Daily HHD– Conventional HHD– CAPD and CCPD– Conventional In
Center– Palliative