The DOPPS Approach to Improving Patient Care

Dr. Friedrich Port is the 2014 recipient of the National Kidney Foundation’s David M. Hume Memorial Award. To mark this milestone in his career, Dr. Port reflected on the approach of the Dialysis Outcomes and Practice Patterns Study (DOPPS), which he helped to design, launch, and maintain since 1996. Dr. Port’s paper “Practice-Based Versus Patient-Level Outcomes Research in Hemodialysis: The DOPPS (Dialysis Outcomes and Practice Patterns Study) Experience” was published in the American Journal of Kidney Disease.

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In the world of dialysis research, observational data are plentiful while clinical trial data are limited. Doctors in this field have to rely on observational studies to evaluate specific treatments and their associations with patient outcomes.  However, it can be difficult to draw meaningful conclusions from observational data. Patients who receive a certain treatment may differ in other ways from patients who do not receive that treatment. This makes it difficult to determine whether any difference in outcome was due to the treatment itself, or due to the underlying differences in the patients.

Successfully accounting for these challenges can lead to substantial gains in knowledge about dialysis treatments. The DOPPS has demonstrated the value of practice-based instrumental variable analyses to overcome the problems associated with patient-level data. This approach makes use of the distinct differences in practice patterns among dialysis facilities, rather than looking only at the differences between patients. In order to produce more meaningful findings, researchers rely on the reasonable assumption that patients choose a dialysis facility without consideration of its specific treatment pattern.

Analyzing data at the facility level has potential limitations, as well. Researchers must observe sufficiently large differences in practice patterns and their analyses should consider that the treatment of interest may be associated with other facility practices.

The examples from the DOPPS outlined in Dr. Port’s paper hopefully will stimulate advances in methodologies and critical clinical work toward improving patient care by identifying beneficial treatment practices applicable to dialysis, chronic kidney disease, and beyond.

CITATION:CITATION: FK Port. Practice-Based Versus Patient-Level Outcomes Research in Hemodialysis: The DOPPS (Dialysis Outcomes and Practice Patterns Study) Experience. Am J Kidney Dis. 2014 Dec;64(6):969-977.
PubMed:www.ncbi.nlm.nih.gov/pubmed/25151407
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