What is the purpose of SAA?
The purpose of Strategic Anemia Advisor (SAA) is to issue recommendations for ESA dosing. SAA is meant to be used for obtaining dosage recommendations only. Providers are solely responsible for reviewing all dosage recommendations before prescribing a dose for a patient. SAA is purely a reference tool and does not replace any clinical protocol or provider judgement. There may be additional clinical factors that affect patients’ ESA responsiveness (such as iron levels, chronic infections, etc.), and users should consider all such factors along with SAA’s recommendations when making clinical decisions. Dosis does not provide medical advice or make clinical, medical or other professional decisions.
Who is the intended user of SAA?
The intended users are anemia managers within clinics. This may include physicians, nurses, nurse practitioners, physician assistants, or any other qualified healthcare designated by a clinic to manage anemia.
What inputs used to generate the recommendations?
The three inputs SAA requires in order to issue recommendations are: a) previous Erythropoiesis Stimulating Agent (ESA) doses, b) previous hemoglobin lab values, and c) hemoglobin target range for each patient. You may recognize these as the same inputs that you are accustomed to taking into account when independently making ESA dosing decisions.
Where does the rationale for the recommendations come from?
The rationale underlying our recommendations, in the form of the mathematical equations that relate the inputs to the output, is available in published literature as well as in our patent (US Patent # 9852267
). You can see an overview of how SAA works here
What are organizations, clinics, patients and users?
SAA is organized around 4 main entities: organizations, clinics, patients and users.
An organization is the business that owns one or multiple clinics.
A clinic is a specific location where dialysis treatment is given. A clinic belongs to an organization.
A patient is a person receiving dialysis treatment. A patient belongs to an organization.
A user is a person who uses SAA. Typically, this is a nurse or a physician/nurse practitioner/physician assistant. A user belongs to an organization.
What do the different roles mean?
Each role comes with a set of permissions. The roles are Organization Admin, Clinic Admin and Staff.
Organization Admin has the ability to view the Edit Organization page and edit the name, Hb target range, phone number, email and address of the organization, as well as the clinics that belong to the organization. Organization Admin can create users who are organization admin, clinic admin or staff. Organization Admin can also do everything that Clinic Admin and Staff can do.
Clinic Admin has the ability to the view the Edit Clinic page and the edit the name, Hb target range, phone number, email and address of the clinic, as well as the staff that belong to the clinic. Clinic Admin can create users who are clinic admin or staff. Clinic Admin can also do everything that Staff can do.
Staff have the ability to see all patients and all clinics that belong to an organization. Staff can run SAA.
What is “Hb target range”?
Hb target range are the upper and lower hemoglobin concentrations that have been determined by the organization to define the hemoglobin target range for treatment. Target ranges can be set at the organization or patient levels. Patient target ranges default to the organization target range, unless they’re specifically overridden by going to the Edit Patient page.
How do I change my password?
You can change your password by clicking on your name in the top right corner and then clicking "Change Password."
How do I view past SAA runs?
You can view past SAA runs by clicking on the "SAA" icon in the left navigation bar and clicking on a past SAA run.
How do I add users to SAA?
If you are a Clinic Admin or Organization Admin in SAA, you can add users by clicking on the "Staff" icon in the left navigation bar and clicking "Add Staff."
How do I print a page from SAA?
You can print an SAA run, an individual patient profile or any page from SAA by going to File>Print on your browser.
How can I get in touch with Dosis for help?
You can email firstname.lastname@example.org or call (650) 383-0186.
What do the metrics mean and how are they calculated?
Percent within Target Range: The Percent within Target Range is the percent of hemoglobin levels within the target range for that particular organization, clinic or patient in a particular period of time. The target range of hemoglobin is set on the Edit pages of organizations, clinics and patients.
At an organization level or clinic level, Percent within Target Range is calculated by taking the number of hemoglobin levels that were within target range for that particular month and dividing it by the total number of hemoglobin levels obtained in particular month.
At a patient level, Percent within Target Range is calculated by taking the number of hemoglobin levels for that patient that are within target range in the performance period and dividing it by the number hemoglobin levels we have for that patient in the performance period.
Percent Followed: The Percent Followed is the percent of SAA recommendations that were followed in a particular period of time. A recommendation is deemed as followed if the user accepts the SAA recommended dose and does not provide a dose override and reason for overriding the dose.
At an organization level or clinic level, Percent Followed is calculated by taking the number of recommendations followed in that particular month and dividing it by the total number of recommendations given that particular month.
At a patient level, Percent Followed is calculated by taking the number of recommendations that were followed for that patient in the performance period and dividing it by the number total number of recommendations given for that patient in that performance period.
Average Hemoglobin: The Average Hemoglobin level is calculated by adding all the hemoglobin levels for a particular performance period and dividing it by the total number of hemoglobin levels. Average hemoglobin is calculated the same way at an organization, clinic and patient level.
Standard Deviation of Hemoglobin: The Standard Deviation of Hemoglobin represents how close to the average hemoglobin value all the actual hemoglobin values are. If you add and subtract the standard deviation from the mean, you will know that 68.2% of all hemoglobin levels are within that range. For example, if the average of a given data set is 100 and the standard deviation is 5, you know that 68.2% of all values are between 95 and 105. If the standard deviation is 20, then 68.2% of all values are between 80 and 120. A lower standard deviation means lower variability.
What has been published on SAA?
The research team behind SAA is based at the University of Louisville, and has published extensively on the technical and clinical steps taken to build and validate SAA. Those publications can be accessed below.
- Gaweda, Adam & A. Jacobs, Alfred & Aronoff, George & Brier, Michael. (2018). Individualized anemia management in a dialysis facility – long-term utility as a single-center quality improvement experience. Clinical Nephrology. 90. 10.5414/CN109499. (https://www.ncbi.nlm.nih.gov/pubmed/30049300)
- Brier, M.E. and A.E. Gaweda, Artificial intelligence for optimal anemia management in end-stage renal disease. Kidney Int, 2016. 90(2): p. 259-61. (https://www.ncbi.nlm.nih.gov/pubmed/27418093)
- Akabua, E., et al., Individualized model discovery: the case of anemia patients. Comput Methods Programs Biomed, 2015. 118(1): p. 23-33. (https://www.ncbi.nlm.nih.gov/pubmed/25459523)
- Gaweda, A.E., et al., Individualized anemia management reduces hemoglobin variability in hemodialysis patients. J Am Soc Nephrol, 2014. 25(1): p. 159-66. (https://www.ncbi.nlm.nih.gov/pubmed/24029429)
- Brier, M.E., et al., Randomized trial of model predictive control for improved anemia management. Clin J Am Soc Nephrol, 2010. 5(5): p. 814-20. (https://www.ncbi.nlm.nih.gov/pubmed/20185598)
- Gaweda, A.E., et al., Iron, inflammation, dialysis adequacy, nutritional status, and hyperparathyroidism modify erythropoietic response. Clin J Am Soc Nephrol, 2010. 5(4): p. 576-81. (https://www.ncbi.nlm.nih.gov/pubmed/20110344)
- Brier, M.E. and A.E. Gaweda, Predictive modeling for improved anemia management in dialysis patients. Curr Opin Nephrol Hypertens, 2011. 20(6): p. 573-6. (https://www.ncbi.nlm.nih.gov/pubmed/21941178)
- Gaweda, A.E., et al., Determining optimum hemoglobin sampling for anemia management from every-treatment data. Clin J Am Soc Nephrol, 2010. 5(11): p. 1939-45. (https://www.ncbi.nlm.nih.gov/pubmed/20671221)
- Gaweda, A.E., A.A. Jacobs, and M.E. Brier, Application of fuzzy logic to predicting erythropoietic response in hemodialysis patients. Int J Artif Organs, 2008. 31(12): p. 1035-42. (https://www.ncbi.nlm.nih.gov/pubmed/19115195)
- Gaweda, A.E., et al., Model predictive control of erythropoietin administration in the anemia of ESRD. Am J Kidney Dis, 2008. 51(1): p. 71-9. (https://www.ncbi.nlm.nih.gov/pubmed/18155535)
- Gaweda, A.E., et al., Individualization of pharmacological anemia management using reinforcement learning. Neural Netw, 2005. 18(5-6): p. 826-34. (https://www.ncbi.nlm.nih.gov/pubmed/16109475)
- Gaweda, A.E., et al., Pharmacodynamic population analysis in chronic renal failure using artificial neural networks--a comparative study. Neural Netw, 2003. 16(5-6): p. 841-5. (https://www.ncbi.nlm.nih.gov/pubmed/12850042)
- Gaweda el al. Using clinical information in goal-oriented learning. IEEE Eng Med Biol Mag. 2007 Mar-Apr;26(2):27-36 (https://www.ncbi.nlm.nih.gov/pubmed/17441606)