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Continuous quality improvement in ESRD: the role of networks, the United States Renal Data System, and facility-specific reports.

Authors
  • Goldman, R S
Type
Published Article
Journal
American journal of kidney diseases : the official journal of the National Kidney Foundation
Publication Date
Dec 01, 1998
Volume
32
Issue
6 Suppl 4
Identifiers
PMID: 9892389
Source
Medline
License
Unknown

Abstract

End-stage renal disease (ESRD) outcome improvement involves many different private and governmental entities. Networks have fulfilled a pivotal role in ESRD quality improvement by facilitating the change from quality assurance (QA) to continuous quality improvement (CQI) methodology, providing the collection and dissemination of outcome measures to facilities and developing quality improvement projects (QIPs) that interface directly with facilities. Improving outcomes in hemodialysis is generally limited to adequacy of hemodialysis and anemia management. Opportunities in peritoneal dialysis, nutrition, vascular access, and quality-of-life outcomes persist. Interaction between facilities and Medical Review Boards (MRBs) using workshops, site visits, and facility report cards can provide continuing ESRD outcome improvement. Every facility has unique people, procedures, and equipment producing their processes of care. Therefore, a certain amount of autonomy is required to encompass individual variation. Quality improvement methodology, although less rigorous than traditional outcome research, provides efficient and effective intervention when a rapid response is required to improve clinical outcomes. The two methods are not mutually exclusive but require distinct methodology to accomplish.

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