Quality Improvement Overview
Quality Improvement
ESRD Networks are required to develop and implement methods to measure and report on the quality of dialysis services provided under the Medicare program. As a result ESRD facilities are required to create an accountable means for providing acceptable levels of dialysis to End Stage Renal Disease (ESRD) patients and to provide comprehensive data that will be used in both assessment of outcomes and initiation of quality improvement programs.
Clinical Performance Measures and the Vascular Access Quality Improvement Project are examples of quality improvement programs where the Network and facilities work collaboratively to put into practice clinical strategies (such as the those outlined in the K/DOQI guidelines) and best practices (collaboratively developed and cooperatively implemented) to enhance performance and improve health and quality of life for patients.
Fistula First
DOQI opened the door for ESRD quality improvement to be to be defined in great measure by the use of the optimum forms of vascular access. Evidence continues to mount that the use of fistulas will diminish costs morbidity permit better dialysis and delivery of adequate dialysis dose.
In 2003 the ESRD Networks and CMS, along with clinicians, dialysis providers, and patients, developed a three-year National Vascular Access Improvement Initiative called FISTULA FIRST. This plan will implement strategies for the improvement of patient vascular access outcomes to reach the CPM and K/DOQI guidelines for AVF use of 50% incidence and 40% prevalence. FISTULA FIRST aims to build on prior work and to take advantage of system-level diagnosis and strategies for improvement. Collaboration between Networks, providers, physicians, vascular surgeons, and health professionals will be key to spread the change of ideas for improving AV fistulas.