We first study and analyze the processes of development of DSS products, and then review risk-reducing techniques employed in their development.
Conducting a randomised controlled trial in multiple centres poses potential problems, namely a lack of standardisation, which is the main issue as different surgeons have different surgical risk-reducing techniques.
What you can do is understand risk, reduce it, and mitigate what you can't eliminate through diversification* and other risk management techniques.
D) Taking risks versus reducing risk. .
The reduced risk of technique failure in higher volume centres was robust to scenarios of unmeasured confounding.
Patients in higher volume centres had a reduced risk of technique failure (>60 patients vs 0 10 patients: adjusted cs-HR 0.46; 95% CI 0.43 to 0.69), with no changed risk of death or transplantation.
Patients initiating peritoneal dialysis in high-volume centres had a considerably reduced risk of technique failure but simulations of interventions to increase exposure to high-volume centres yielded only modest improvements.
This work has been globally encouraging, with all five studies until now finding a reduced risk of technique failure in larger centres 12 16 with either equivalent 12 14 16 or lower 15 mortality in larger centres.
Increasing centre volume was associated with a reduced risk of technique failure at 5 years of follow-up, with cs-HRs decreasing as centre volume increased in a dose response pattern (figure 1).
14 17 However, it is not yet clear if the reduced risk of technique failure observed in high-volume centres is a causal effect or, rather, is due to unmeasured confounding.
45 Overall, our findings suggest that patients initiating peritoneal dialysis in high-volume centres have a reduced risk of technique failure without any change in the risk of death but that policies and interventions to increase patients' exposure to high-volume centres in routine care may yield only modest improvements in technique failure.
