Diamond Louis H, Howard Andrew D
Quality Health Care Advisory Group, Huntington, NY; and Metropolitan Nephrology Associates, Clinton, MD.
Quality Health Care Advisory Group, Huntington, NY; and Metropolitan Nephrology Associates, Clinton, MD.
Adv Chronic Kidney Dis. 2016 Nov;23(6):377-384. doi: 10.1053/j.ackd.2016.11.007.
This article describes the current state of facilitating the integration of evidence into practice to support initiatives focused on patients with ESRD. We will use the Centers for Medicare and Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) as an example, including a description of the health information infrastructure needed to support the translation of evidence into practice and some of the challenges encountered. The process from the generation of evidence to integration of this evidence into practice includes policy development leading to clinical practice guidelines, clinical performance measures, and clinical decision support tools. The ESRD QIP is the most mature program outside the hospital initiatives in the CMS Quality Payment Program and currently contains 16 measures. ESRD data to support these measures are aggregated at the dialysis facility level and reported through the CMS Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) and the Centers for Disease Control and Prevention using the National Healthcare Safety Network. We review these measures and the health information infrastructure used to report the data, focusing on the inherent strengths and weaknesses of the ESRD QIP along with opportunities for improvement of the program.
本文描述了促进将证据整合到实践中以支持针对终末期肾病（ESRD）患者的倡议的当前状况。我们将以医疗保险和医疗补助服务中心（CMS）的ESRD质量激励计划（QIP）为例，包括对支持将证据转化为实践所需的健康信息基础设施的描述以及所遇到的一些挑战。从证据产生到将该证据整合到实践中的过程包括导致临床实践指南、临床绩效指标和临床决策支持工具的政策制定。ESRD QIP是CMS质量支付计划中医院外倡议中最成熟的计划，目前包含16项指标。支持这些指标的ESRD数据在透析机构层面进行汇总，并通过CMS基于网络的综合肾脏运营（CROWNWeb）以及疾病控制与预防中心使用国家医疗安全网络进行报告。我们审查这些指标以及用于报告数据的健康信息基础设施，重点关注ESRD QIP固有的优势和劣势以及该计划的改进机会。
