Value of Quality Improvement Reporting

Abstract

Mortality among patients who are on dialysis in the United States is high, especially within the first 90 d after initiation of dialysis (1). How can this problem be addressed? A typical model for solving such clinical dilemmas begins with intensive clinical research to identify causes and correlates of mortality as well as strategies to improve outcomes. This is often followed by the development of evidence-based clinical practice guidelines or recommendations by expert advisory panels. Although such evidence-based clinical practice guidelines often provide recommended clinical targets ( e.g. , glycosylated hemoglobin <7% for patients with diabetes), specific strategies for achievement of these targets (beyond choice of medications in some cases) are usually not offered. Because of the lack of specific implementation recommendations within practice guidelines, quality improvement programs are often initiated within medical practices or institutions to translate the results of clinical research and the recommendations of experts into effective practice in their unique environments. Such programs usually have as their goals standardization of care and improvement of processes with the ultimate aim of improving patient outcomes. Within nephrology, particularly within the realm of ESRD, all of these steps are being carried out. Unfortunately, there are problems and controversies at each level. First, clinical research in the dialysis arena has been largely observational with few randomized control trials to guide clinical decision making and development of guidelines (2). Second, the process of guideline development has been tainted by the specter of pharmaceutical influence (3–5). Finally, although quality improvement programs …