Northwest Kidney Centers; Division of Nephrology, University of Washington School of Medicine, Seattle, WA 98122, USA.
Clin J Am Soc Nephrol. 2012 Oct;7(10):1673-81. doi: 10.2215/CJN.01750212. Epub 2012 Jul 19.
With the issuance of the new Conditions for Coverage in 2008 and the implementation of the Prospective Payment System in 2011, the Centers for Medicare & Medicaid Services has fundamentally altered the regulatory landscape of quality in the ESRD program. Although these changes-largely through use of tools comparing individual facility performance to regional and national quality expectations-have increased facility accountability for the quality of patient care in many quarters, they have also complicated both substance and process of facility adherence to quality rules in that component of the program. This editorial critically assesses the main quality tools now in use for dialysis facilities and reviews the issues arising from their conjoint use. A scheme for improving the effectiveness of each quality tool is proposed, and an assessment of their future value and effectiveness in quality improvement is offered.
随着 2008 年新的覆盖条件的发布和 2011 年预期支付制度的实施，医疗保险和医疗补助服务中心从根本上改变了 ESRD 计划中质量的监管环境。尽管这些变化——主要是通过使用将单个机构的绩效与区域和国家质量预期进行比较的工具——在许多方面增加了机构对患者护理质量的责任，但它们也使该计划的这一部分的机构遵守质量规则的实质和程序变得更加复杂。本社论批判性地评估了目前用于透析设施的主要质量工具，并审查了它们联合使用所产生的问题。提出了一种改进每种质量工具有效性的方案，并对其在质量改进方面的未来价值和有效性进行了评估。
