Wish J, Roberts J, Besarab A, Owen W F
Division of Nephrology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, OH, USA.
Adv Ren Replace Ther. 1999 Jan;6(1):67-74. doi: 10.1016/s1073-4449(99)70010-5.
For a clinical practice guideline to be accepted by the end-user, the system of reimbursement for the targeted service must be favorable. The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Guideline recommendations were developed without primary concern for the costs of their execution. Arguably, an unfavorable financial environment and excessive mercantile behavior by providers and payers would offer a considerable hindrance to their implementation. Toward addressing these concerns, three leaders in the development of the DOQI Guidelines for the Treatment of Anemia of Chronic Renal Failure, Hemodialysis Adequacy, and Vascular Access, have evaluated the hypothesis that implementing the recommendations of the DOQI Guidelines will increase the treatment costs for dialysis providers but will effect savings in the entire end-stage renal disease (ESRD) program. Their analyses suggest that under the current reimbursement system, this assumption may be true. However, restructured global reimbursement in the ESRD program will permit financial incentives for dialysis providers and the payer to coincide.
要使临床实践指南被最终用户接受，针对目标服务的报销制度必须有利。美国国家肾脏基金会透析预后质量倡议（NKF - DOQI）指南建议的制定并未将执行成本作为首要考虑因素。可以说，不利的财务环境以及提供者和付款方过度的商业行为会对这些建议的实施造成相当大的阻碍。为了解决这些问题，慢性肾衰竭贫血治疗、血液透析充分性及血管通路的DOQI指南制定过程中的三位负责人，对实施DOQI指南建议会增加透析提供者的治疗成本，但会在整个终末期肾病（ESRD）项目中实现成本节约这一假设进行了评估。他们的分析表明，在当前报销制度下，这一假设可能成立。然而，ESRD项目中重构的整体报销方式将使透析提供者和付款方的经济激励相契合。
