The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #57283

Carl W. Nelson, PhD, Northeastern University, 319 Hayden, 365 Huntington Avenue, Boston, MA 02115, 617-373-4751, ca.nelson@neu.edu

Research demonstrates that chronic renal failure has many preventable causes as well as significant diagnostic and treatment physician practice pattern variation. Racial and ethnic disparities also play an important role as disease determinants and in the selection of treatment options. This study pioneers the use of “double fishbone” diagram. A conventional fishbone diagram drawn on the left focuses on underlying causes of the disease. Major and minor branches of this part of the diagram are drawn from analysis of published studies and expert opinion. The right side of the diagram continues from the ESRD diagnosis and is used to establish major and minor branches that delineate available treatment options. Specific paths in the network highlight racial and ethnic disparities as assignable causes of variation. These high complexity/high cost paths in the network draw attention to sub-optimal prevention and treatment strategies and the important task of directing broad total quality improvement efforts to vulnerable populations.

Learning Objectives:

• 1.Understand the contribution of race and ethnicity as causal determinants of renal failure.
• 2.Learn how race and ethnicity may influence the course of treatment for renal failure.
• 3.Introduce a modified version of the cause-and effect industrial quality control graphic tool to characterize these variations and draw attention to appropriate prevention, diagnostic, and treatment strategies.

Keywords: Quality Improvement, Vulnerable Populations

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.