The International Society of Nephrology collaborative quality framework to support safe and effective dialysis provision in resource-challenged settings.

Abstract

Global under-provision of affordable dialysis results in inequitable access to safe and effective treatment. Identified as a key priority for the International Society of Nephrology (ISN) Kidney Failure Strategy, the need was identified for a dialysis quality framework that would set minimum standards for safe and effective treatment. In addition, this framework, which was developed through collaboration and iterative review to ensure external validity, links these standards to resource requirements and suggested reporting tools. It includes elements that are designed to minimise catastrophic healthcare expenditure by mandating transparent individualised affordable dialysis planning and encourages continuous quality improvement by including a tiered approach to standards. Although a set of minimum mandatory standards is included, with a strong focus on patient safety, this is not intended as a goal for all, but to support the incremental development of dialysis in the most challenging resource settings. Providers and funders are expected to engage with the framework at a level commensurate with their resources, clearly identifying where lack of resource is leading to sub-optimal quality. In this way the framework empowers policy makers, healthcare commissioners and patient groups to work with providers to ensure quality and meet demand.