Effect of variability in XXXX management on hemoglobin outcomes in @entity454 .

@entity1 @entity417 @entity1307 @entity68 @entity454
BACKGROUND: Hemoglobin (Hgb) levels fluctuate in @entity1 with @entity454 over time. This study quantified Hgb level variability and the likelihood of falling within the Hgb level goal range of 11 to 12 g/dL. Implications on the percentage of @entity1 exceeding 3-month rolling average Hgb levels of 12, 12.5, and 13 g/dL were determined. METHODS: Phase I (n = 65,009) tracked @entity1 with Hgb values initially outside the goal range (<11 or >12 g/dL) during 2000. Correlation with facility-specific thresholds also was evaluated. Phase II (n = 48,133) quantified variation in 3-month rolling average Hgb levels in a subset with greater than 10 months of data (mean Hgb, 11.4 +/- 1.3 g/dL). RESULTS: A total of 24,948 @entity1 (38.4%) had Hgb levels between 11 and 12 g/dL. In only 8% did Hgb levels consistently remain less than 11 g/dL, and in 18%, greater than 12 g/dL all year. Twenty-nine percent (18,633 @entity1 ) moved from below to above target range or vice versa. Greater mean facility Hgb level correlated with a greater percentage of @entity1 with Hgb levels greater than 10 g/dL (R2 = 0.49) and greater than 12.5 g/dL (R2 = 0.61). For facilities to have 90% or greater of @entity1 with 3-month rolling average Hgb levels greater than 10 g/dL, 13% to 31% of @entity1 will have 3-month rolling average Hgb values greater than 12.5 g/dL. The average individual @entity1 is expected to have a +/-1.4-g/dL fluctuation in 3-month rolling average Hgb levels per year. Despite increased mean Hgb levels and @entity1307 (EPO) and @entity68 use, the spread of the Hgb distribution curve remained unchanged in the last 6 years. CONCLUSION: Variability caused by laboratory assays, biological factors, and therapeutic response determines @entity1 Hgb level variability. Improving factors that can be manipulated (eg, standardizing EPO and @entity68 algorithms) and adjustment of the target Hgb level range, specifically, by increasing the upper bound, likely will decrease the observed variability and further enhance the quality of @entity417 management.
