McClellan W M, Helgerson S D, Frederick P R, Wish J B, McMullan M
Clark-Holder Clinic, LaGrange, GA 30240, USA.
Adv Ren Replace Ther. 1995 Apr;2(2):89-94. doi: 10.1016/s1073-4449(12)80078-1.
Improving the quality of health care is a central challenge for America's health care system. The mission of the End-Stage Renal Disease (ESRD) program is to promote the quality, effectiveness, and efficiency of ESRD patient care and program administration. The program provides an ideal opportunity to demonstrate the use of information to help clinicians analyze and improve the care they deliver to patients in an ambulatory setting. This is possible because the program has established regional surveillance systems, called ESRD Networks, that gather information on the occurrence and outcomes of treatment of Medicare beneficiaries with ESRD. The Health Care Financing Administration, which is responsible for the administration of the program, and the renal community have worked together since 1990 to identify ways of incorporating new methods of quality improvement into the program. These methods include statistical evaluation of the processes and outcomes of care in dialysis populations; communicating recommended practices with clinical guidelines and algorithms; regional peer review and feedback (ie, technical assistance and/or collaborations for quality improvement); interventions that focus on the provision of assistance for quality improvement efforts; continuing collection and active feedback of data to providers; and a commitment to continue to evaluate and revise quality improvement activities to reflect lessons learned and newly identified needs. These ideas have been included in the 1994-1997 scope of work for the ESRD Networks and is called the ESRD Health Care Quality Improvement Program (HCQIP). This article describes the background for the ESRD HCQIP and the program's elements.
提高医疗保健质量是美国医疗保健系统面临的核心挑战。终末期肾病（ESRD）项目的使命是提升ESRD患者护理及项目管理的质量、有效性和效率。该项目提供了一个理想的契机，用以展示如何利用信息帮助临床医生分析并改善他们在门诊环境中为患者提供的护理。之所以能够做到这一点，是因为该项目建立了名为ESRD网络的区域监测系统，该系统收集有关医疗保险受益的ESRD患者治疗发生情况及结果的信息。负责该项目管理的医疗保健财务管理局与肾脏学界自1990年以来一直合作，以确定将新的质量改进方法纳入该项目的方式。这些方法包括对透析人群护理过程和结果进行统计评估；将推荐做法与临床指南及算法进行沟通；区域同行评审与反馈（即质量改进方面的技术援助和/或合作）；专注于为质量改进工作提供援助的干预措施；持续收集数据并向提供者提供积极反馈；以及承诺持续评估和修订质量改进活动，以吸取经验教训并反映新发现的需求。这些理念已被纳入ESRD网络1994 - 1997年的工作范围，被称为ESRD医疗保健质量改进项目（HCQIP）。本文介绍了ESRD HCQIP的背景及该项目的要素。
