What DMAR systems provide

DMAR web-based software is normally installed into the local health care environment to meet local privacy and security standards. DMAR systems have undergone rigorous review including provincial Privacy Impact Assessments (PIA) and third party threat risk assessments (TRA).

We can provide cloud hosting solutions but it is usually reserved for de-identified patient data.

Once privacy and security standards are met, we provide on-site or web based training of staff to begin creating a culture of data quality. Users are provided continuous review of their data and on-line coaching by experts on the system. We believe in providing the necessary training and support to create a strong foundation of accurate data within the health care team. The delivery of health care increasingly means being accountable for results.

Our specific services include:

Activity tracking for renal programs

DMAR systems provides clinical activity tracking software for the Renal Program at Sunnybrook Health Sciences Centre which is a University of Toronto affiliated teaching hospital. DMAR software provides data exports for the Ontario Renal Reporting System, physician billing, quality improvement and peer-reviewed research. It has been operational since 2008.

Optimizing the use of home dialysis

DMAR systems accurately benchmark the key drivers of home dialysis use. 1

Below is an example of how a typical dialysis program optimized the factors that determine incident use of PD. The accumulative impact of these changes increased Peritoneal Dialysis (PD) use from 17% to 38% amount new patients staring chronic dialysis.

Before DMAR After DMAR
Team identifies PD candidates 95% 100%
Team assesses for PD eligibility 85% 95%
Patient is considered eligible 60% 80%
Patient is educated about PD 90% 100%
Patient choses PD 45% 55%
Patient receives PD 85% 90%
Patient starting PD 17% 38%

Health care leaders wishing to grow home dialysis face many challenges. The table below describes the many advantages of using DMAR systems to grow home dialysis.

Steps to increase home dialysis Before DMAR After DMAR
Determine the barriers to growth of home dialysis by performing a literature search, speaking to leaders in your program, searching the internet, creating a patient focus group Review revealed many potential barriers to home dialysis:
  • Patient – age, comorbidity, lack of support, residential issues
  • Provider – lack of knowledge, bias towards in-centre, reimbursement issues, PD catheter placement, staff turnover
  • System factors – wait times for PD catheters, crash starts, lack of training spots
  • DMAR provides a 10 step framework for understanding home dialysis growth.
  • Data collected in the program diagnoses your specific barriers.
Design an intervention(s)
  • Need to create a committee to design the intervention.
  • Normally requires a significant commitment of time.
  • Can be time consuming to fine tune the intervention and work out all the steps.
  • The DMAR system has been fine-tuned over many years and is ready to implement now.
  • Implementing DMAR cleans up the process of care which often results in immediate home dialysis growth
  • Early analysis allows us to implement specific interventions based on our extensive experience in other dialysis programs
Data collection
  • Create a set of baseline and outcomes data elements
  • Create definitions
  • Create data collection tool (e.g. modify EMR, excel spreadsheet)
  • Allocate staff time for data collection
  • Ensure data quality
  • Iteratively improve the dataset based on pilot data, analysis etc.
  • DMAR dataset is already established
  • Well worked out definitions and coding system
  • Can distribute workload over multiple staff
  • Centralized review by experts ensures data quality
Analysis to measure impact
  • May not have access to statisticians familiar with dialysis
  • May be limited to basic analysis (no adjustment for patient factors)
  • No benchmarking to other programs
  • Access to dedicated DMAR analysts
  • Adjusted analyses
  • Comparison to other programs across Canada
  • Once intervention is implemented successfully there is a need to ensure it is maintained.
  • Other problems could arise reducing home dialysis use.
  • DMAR simultaneously measures all 10 drivers of PD use.
  • Our process enforces ongoing rigor to ensure home dialysis is optimized

1 Blake PG, Quinn RR, Oliver MJ. Peritoneal dialysis and the process of modality selection. Peritoneal Dialysis International. 2013 May-Jun;33(3):233-41.

Optimizing the use of vascular access

DMAR systems provide comprehensive measurement of vascular access procedures, patency, use and associated outcomes. We go beyond “fistula first” and determine if resources are efficiently achieving results.

DMAR systems help programs determine if vascular access procedures and their associated costs are achieving the goals of proving reliable vascular access with acceptable levels of complications. We don’t believe in fistula use at any cost but rather direct measurement of which access was created, used, and associated rates of procedures and complications. This information allows programs to intelligently manage access complications and risks. This approach improves patient outcomes and lowers cost.

Recently, we published an important paper showing that most of the survival benefit of a fistula is likely selection bias which has made the renal community rethink the best approach to vascular access. 2

2 Quinn RR, Oliver MJ, Devoe D, Poinen K, Kabani R, Kamar F, Mysore P, Lewin AM, Hiremath S, MacRae J, Matthew James MT, Miller L, Hemmelgarn BR, Moist LM , Garg AX, Chowdhury TT, Ravani P. The impact of fistula attempt on risk of access-related death. Journal of Am Soc Nephrology. 2016 Sep.

Improving health performance measurement

The patented methods in the DMAR system can be applied to any health care area to measure performance. We can assist any organization improve data definitions, coding systems, training methods, data review and analysis. We have over 10 years’ experience maintaining high quality data systems at a reasonable cost.

Currently many health care organizations are collecting large quantities of data and consuming vast quantities of health care professionals’ valuable time. An important question is whether leaders have high confidence in this data and whether it is providing information to make better decisions.