Abstract: Objective To explore the effect of PDCA (plan, do, check and act) management on the improvement of mineral metabolism disorder in maintenance hemodialysis (MHD) patients in order to improve quality management for hemodialysis patients. Methods Since Jan. 1st, 2013, the PDCA, a 4-step problemsolving irame work of continuous quality improvement (CQI), was carried out for the management of mineral metabolism disorder in MHD patients who were stable for more than 3 months in one hospital in Beijing. A total of 90 MHD patients treated in the hospital with complete clinical data within 12 months from Jan. 2011 to Dec. 2012 (control group) and from Jan. 2014 to Dec. 2015 (intervention group) were enrolled in this study. Clinical characteristics and mineral metabolism parameters including serum Ca, P and intact parathyroid hormone (iPTH) were extracted from digital clinical record system. Variability and mean of the parameters were calculated. Changes of mineral metabolism parameters were compared between the two groups. Results In intervention group and control group before PDCA management, serum Ca increased from 2.23±0.19 mmol/L to 2.27±0.14 mmol/L (t=1.347, P=0.178), serum P decreased from 1.90±0.45 mmol/L to 1.71±0.35 mmol/L (t=-1.791, P=0.073), and serum iPTH decreased from 297.63±233.25 mmol/L to 293.46±227.44 mmol/L (t= 0.049, P=0.961). These changes had no statistical significances. After the intervention, the variation of serum P between the two groups decreased from 1.16±0.59 mmol/L to 0.98±0.48 mmol/L (t=-2.089, P=0.037), the coefficient of variation (CV) of serum iPTH between the two groups decreased from 0.47±0.23% to 0.35± 0.20% (t=-2.528, P=0.011). The mean, range and CV of serum Ca, the mean and CV of serum P, the mean and range of serum iPTH, and the abnormal ratio of serum Ca, P and iPTH were similar between the two groups.Conclusions PDCA management improves mineral metabolism in MHD patients, and is thus useful for the management of MHD patients.

Key words: PDCA, Hemodialysis, Mineral metabolism, Variability