Portland VA Medical Center and Oregon Health and Sciences University, Portland, OR.
VA Connecticut Healthcare System, West Haven, and Yale University School of Medicine, New Haven, CT.
Am J Kidney Dis. 2014 Mar;63(3):521-9. doi: 10.1053/j.ajkd.2013.10.046. Epub 2013 Dec 11.
The first governmental agency to provide maintenance hemodialysis to patients with end-stage renal disease (ESRD) was the Veterans Administration (VA; now the US Department of Veterans Affairs). Many historical VA policies and programs set the stage for the later care of both veteran and civilian patients with ESRD. More recent VA initiatives that target restructuring of care models based on quality management, system-wide payment policies to promote cost-effective dialysis, and innovation grants aim to improve contemporary care. The VA currently supports an expanded and diversified nationwide treatment program for patients with ESRD using an integrated patient-centered care paradigm. This narrative review of ESRD care by the VA explores not only the medical advances, but also the historical, socioeconomic, ethical, and political forces related to the care of veterans with ESRD.
第一个为终末期肾病 (ESRD) 患者提供维持性血液透析的政府机构是退伍军人管理局 (VA; 现称美国退伍军人事务部)。许多历史悠久的 VA 政策和计划为后来对 ESRD 退伍军人和非退伍军人患者的护理奠定了基础。最近的 VA 倡议旨在根据质量管理、全系统支付政策以促进更具成本效益的透析以及创新拨款来调整护理模式，以改善当代护理。VA 目前采用以患者为中心的综合护理模式，为 ESRD 患者提供广泛和多样化的全国性治疗方案。本文对 VA 进行的 ESRD 护理的叙述性回顾不仅探讨了医学进步，还探讨了与 ESRD 退伍军人护理相关的历史、社会经济、伦理和政治因素。
