ESRD patients on long-term dialysis in Ankeng
With secondary hyperparathyroidism (iPTH>300)
Local population ~120,000
1,300 HD sessions/month
Our team employs an integrated model combining Clinical Audit, Shared Decision-Making (SDM), and a Smart Application to effectively manage Secondary Hyperparathyroidism (SHPT) in hemodialysis patients. Four core tools: (1) Clinical Audit based on Taiwan Society of Nephrology KDOQI guidelines, tracking iPTH control rate and Ca×P; monthly compliance 98.6%; (2) Quality Control Circle for cross-departmental improvement; (3) Shared Decision-Making (SDM) for iPTH>800pg/mL high-risk patients, offering parathyroidectomy, oral calcimimetics, vitamin D options — 17 patients completed; (4) Smart App: self-developed Renal Phosphorus Diet App with keyword search, category search, and dining-out calculation; 500+ downloads. Outcome: iPTH>300pg/mL reduced from 50.7% (2020) to 25% (2022), below the national average of 40.1%.
6-step Clinical Audit + PDCA improvement
SDM 3-option standardized decision pathway
Self-developed Renal Phosphorus Diet App
30-min intradialytic cycling adjunctive therapy
Cross-institutional big data analysis
Monthly audit compliance: 98.6%
SDM completed: 17 patients
Hemodialysis: 1,300 sessions/month
Peritoneal dialysis: 10/month
Renal Phosphorus Diet App: 500+ downloads
iPTH>300pg/mL: 50.7% → 25%
Below national average (40.1%)
iPTH testing rate: 100%
Appropriate treatment rate: 96%
Ca×P compliance rate: 88.8%
In-unit fall events: 0
Out-of-unit fall fractures: 3/113
No fall-related deaths
Bed spacing ≥1.5 m
Dedicated isolation room for infections
Survey response rate: 97.5%
Overall satisfaction: 87.4 / 100
Annual satisfaction after SNQ: 90%
Publicly recognized appreciation letters: 10
High recognition for renal osteodystrophy care
8 SCI papers published in 2023
Nephrology (2018) invited review cited 114 times
2024/5: ERA Congress presentation
2024/10: ASN Meeting presentation
Cross-institutional TrinetX analysis
Performance exceeds national average
Cross-institutional data provides SDM evidence
Bedside exercise establishes clinical evidence
Replicable model for regional hospitals
