Kurtin P S
Children's Hospital and Health Care, San Diego, CA 92123, USA.
Am J Kidney Dis. 1995 Apr;25(4 Suppl 1):S8-11. doi: 10.1016/0272-6386(95)90674-6.
Quality improvement theory teaches that, as providers of health care, physicians must determine and then meet the needs of their primary customers, the patients and payers. The needs of patients and payers are met and measured by the outcome of services and treatments delivered by providers to patients. In general, outcomes fall into three main categories: clinical, financial, and patient based. All parties within the end-stage renal disease (ESRD) community seek the best value (quality/cost) when receiving, delivering, or paying for ESRD services. Because there is not yet a consensus on the definition(s) of quality in the care of ESRD patients, a determination of value remains largely cost dependent. Thus payers, who have no easy or reliable way to compare the quality of providers, based many of their decisions on the best available price. Patient-based outcomes include the assessment of patient satisfaction and health status (health-related quality of life). These outcomes broaden the perspective on quality of care beyond the clinical and laboratory measures traditionally used in the ESRD Program. The assessment of these outcomes can give providers additional insights into the burdens of renal failure and its treatment on the lives of their patients. This information then can be used to design or modify the services provided. Physicians are required to provide high-quality, effective, appropriate, and cost-efficient services. How to meet the often conflicting outcome needs of payers and patients remains a significant challenge. It is essential that all within the ESRD community reach some agreement on the operational definition(s) of quality process and outcome indicators.(ABSTRACT TRUNCATED AT 250 WORDS)
