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Tuesday, September 1, 2009

Dialysis Quality Standards

Sections of Dialysis Quality Standards

Dialysis Quality Standards

• Since the 1970s, quality in dialysis has been checked by comparing centers to preset standards. This is called quality assurance.
• Centers that do not meet these standards risk losing their Medicare certification to provide ESRD services and the payment they receive for these services.

Reasons for measuring dialysis quality:
1. The original purpose of dialysis was not just to keep patients alive, but to allow them to be active and productive citizens.
2. Congress requires assurance that the Medicare ESRD Program is worth the money, in part by showing that good quality care is being provided. 
3. Healthcare costs in general have skyrocketed. There is pressure throughout medicine to look at how well patients are doing, in or.ler to reduce costs while still maintaining quality care.

• Centers for Medicare and Medicaid Services (CMS)
     • Is the federal body that oversees Medicare
     • Formerly called Health Care Financing Administration (HCFA)
     • Inspects dialysis centers through contracts with state Departments of Health.
     • State surveyors have checklists of standards and conditions that centers must meet to keep their certification.
     • Centers that do not meet these can lose their Medicare funding.

• Many other dialysis standards exist:
ESRD Networks have Medical Review Boards that collect patient and center data to measure outcomes.
• The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has standards for hospital-based dialysis centers.
• The Association for the Advancement of Medical Instrumentation (AAM1) has standards for dialysis water treatment, dialysis solution preparation, and dialyzer reprocessing.

The Food and Drug Administration (PDA) oversees the safety and effectiveness of all medical devices.
• In 1991 PDA put out Quality Assurance Guidelines for Hemodialysis Devices.
• Still in effect, cover dialyzer and blood tubing, monitoring devices and alarms, dialysis machines, dialyzer reprocessing equipment, water treatment, and all other dialysis devices.

National dialysis data can serve as standards.
• The United States Renal Data System (USRDS)
• Puts out a report each year that compares data from all dialysis centers in the United States.
• Data include annual mortality (death) rate, number of patients, cost of treatment, and much more.
• The results may be used to find out if outcomes for all patients are getting better or worse.
• Centers can use the data to compare their outcomes with national averages.

ESRD Clinical Performance Measures (CPMs) project
• This is a team effort of CMS, the ESRD Networks, and dialysis centers.
• Compare the quality of Medicare dialysis.
• Data are gathered each year from a random sample of patients from each center.
• Are based on the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQF") Clinical practice Guidelines
• The hemodialysis CPMs are adequacy of dialysis, vascular access, anemia, and albumin.
• A report is put out each year.

Dialysis Quality Standards - Related Hemodialysis Article


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