- Email: [email protected]
On the winds of change
NKF
PRESIDENT’S
COLUMN
On the Winds of Change Garabed Eknoyan, MD President,
National Kidney Foundation
T
on patient care, specifically the quality of care of end-stage renal disease patients. Despite major improvements in dialysis technology and knowledge, end-stage renal disease patients continue to suffer from the debilitating effects of renal disease and to die prematurely. It is this concern that instigated the NKF, at the prompting of its immediate Past-President Alan Hull, to launch in 1994 its Controversies in the Quality of Dialysis Care program that culminated in a Plan for the Continuous Quality Improvement of Dialysis Care, which was adopted by the NKF Board of Trustees at its meeting of November 1994. It is as an outgrowth of this plan that in March 1995, the NKP launched its Dialysis Outcome Quality Initiative (NKF-DOQI). Over the past 2 years, more than 70 individuals have worked
HIS inaugural column reflects one of the many changes affecting the National Kidney Foundation (NKF). One of these is the change in editorship of the American Journal of Kidney Diseases from the able leadership of Saul0 Klahr over the past 5 years to that of an innovative future charted by the new editor, Neil Kurtzman. In fact, it was his idea that a quarterly President’s Column be initiated in the Journal to keep the professional membership of the NKP abreast of the ongoing activities of the Foundation. As a past-president of the NKF, Dr Kurtzman, more than others, appreciates the value of keeping the professional membership of the NKF informed of its activities. Since subscription to the Journal is one of the benefits of professional membership in the Foundation, this should serve as a unique tool of communication. It is to that end that I intend to use it. However, no communication achieves its full potential unless it transmits a message that elicits a response. It is with that in mind that I invite readers of the NKF President’s Column to take the initiative to respond directly to me. After all, the strength of the Foundation is in its membership, and while the support they provide assumes many forms (financial contributions, voluntary service, advocacy of policies), one of the more precious of them is providing constructive criticism, novel ideas, and new programs. As such, one of my motivations in accepting the invitation of Neil Kurtzman is to establish a new two-way communication with the membership of the Foundation. In this first report, I would like to review three of the principal events of the past year that will impact the future activities of the Foundation. The one that temporally antecedes the other two, and has consumed more of my time over the past 3 years, is what can be considered a return of the Foundation to its roots of impacting directly American
Journal
of Kidney
Diseases,
Vol 29,
No 6 (June),
diligently to review the literature and develop rigorous and evidence-based clinical practice guidelines for the adequacy of hemodialysis and peritoneal dialysis, anemia, and vascular access. Their development has been one of the most cooperative, rewarding, and unifying efforts of the entire renal community. Together with Nathan Levin, I had the privilege of co-chairing the process. The guidelines are due for release in the spring of 1997. From the outset, the guidelines were intended only as a first step in attaining one goal: improved patient outcomes. Thus, it is their implementation that is the main goal of NKF-DOQI. Based on broad-based input, three types of activities are planned for the next 3 years to achieve this end: translating the recommendations into practice 1997:
pp xxxix-xl
xxxix
XI
through a series of core educational programs and tools; promoting a commitment to reduce practice variation by working with providers and insurers to adopt the guidelines; and developing performance measures to evaluate and assess compliance in an effort to validate and improve the guidelines over time. The spirit of cooperation and exemplary volunteerism that has gone into development of these guidelines has been a unique and rewarding experience. It is only this spirit and commitment that will help NKF-DOQI in its goal to place quality improvement directly into clinical practice. Your individual input, support, and efforts are absolutely essential to the success of this worthwhile goal. The second change I would like to mention is that of the founding of the Council of American Kidney Societies (CAKS) in 1996. The need for various organizations concerned with kidney and urologic diseases to present a unified front both on the Hill and the National Institutes of Health Campus led to establishment of the Intersociety Council. Because of the rather varied needs of the broad constituency of the Intersociety Council, CAKS was founded to strengthen and focus more directly on the needs of the renal community. It is composed of five sister renal organizations: American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplant Physicians, Renal Physicians Association, and the NKF, each represented by its current president. The stated purpose of CAKS is to “serve as a representative body of scientific and professional practice organizations in the promotion and support of clinical and basic research in the broad field of kidney diseases, in promotion and support of the practice of the broad field of adult and pediatric nephrology, and in promotion and support of the policies which affect the broad field of kidney diseases.” The CAKS has just begun to work toward that purpose. To this end, it has adopted a research and training agenda that was shared with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and presented to the National Institutes of Health Director, Harold Varmus; it has met with the leadership of the American College of Physicians asking for ear-
lier input and a voice in its activities as they pertain to the subspecialty of nephrology; it has nominated and supported the appointment of Barbara Hayes to the NIDDK Advisory Council; and it is in communication with the NIDDK for input into research priorities and future clinical trials. At the legislative level, a Congressional Breakfast and Day on the Hill is planned for April 15,1997. With such a start, CAKS is bound to have a promising future. The third change is an agreement with the American Society of Nephrology to merge in the presentation of a single Fall Scientific Program, beginning this year. The NKF will be represented by three members on the lo-member Program Committee, and will provide direct input through its Scientific Councils. The vice-chair of the Program Committee will be appointed by the NKF. For the 1997 Program Committee this is Jacques Bourgoignie; for 1998, it will be Manuel Martinez-Maldonado. From the NKF perspective, this will not only strengthen the Fall Scientific Meetings it had inaugurated and traditionally organized, but will also allow it to better focus on the Annual Spring Clinical Nephrology Meetings. When the Spring Clinical Nephrology Meetings were launched in 1993, the intent was twofold. First, to provide an alternative to the fall program since clinical demands require coverage and precluded everyone from attending a nephrology CME program annually. The second was to provide greater focus on clinical problems. The agreement with the American Society of Nephrology now allows for the NKF to concentrate more of its efforts on the Spring Clinical Nephrology Meetings. Donald Wesson will chair the 1998 program, and William Keane will serve as chair in 1999. They have the challenge to elevate the spring meetings to new and higher levels of achievement. I am personally grateful for their accepting this challenge. I invite all of you to attend these meetings and to determine whether they have met the challenge. In closing, I would again like to reiterate my request for your input in any and all matters that pertain to the NKF. I need your ideas, criticisms, and suggestions. It is only with your input and support that the NKF can maintain the growth and success it has achieved in the past.
PRESIDENT’S
COLUMN
On the Winds of Change Garabed Eknoyan, MD President,
National Kidney Foundation
T
on patient care, specifically the quality of care of end-stage renal disease patients. Despite major improvements in dialysis technology and knowledge, end-stage renal disease patients continue to suffer from the debilitating effects of renal disease and to die prematurely. It is this concern that instigated the NKF, at the prompting of its immediate Past-President Alan Hull, to launch in 1994 its Controversies in the Quality of Dialysis Care program that culminated in a Plan for the Continuous Quality Improvement of Dialysis Care, which was adopted by the NKF Board of Trustees at its meeting of November 1994. It is as an outgrowth of this plan that in March 1995, the NKP launched its Dialysis Outcome Quality Initiative (NKF-DOQI). Over the past 2 years, more than 70 individuals have worked
HIS inaugural column reflects one of the many changes affecting the National Kidney Foundation (NKF). One of these is the change in editorship of the American Journal of Kidney Diseases from the able leadership of Saul0 Klahr over the past 5 years to that of an innovative future charted by the new editor, Neil Kurtzman. In fact, it was his idea that a quarterly President’s Column be initiated in the Journal to keep the professional membership of the NKP abreast of the ongoing activities of the Foundation. As a past-president of the NKF, Dr Kurtzman, more than others, appreciates the value of keeping the professional membership of the NKF informed of its activities. Since subscription to the Journal is one of the benefits of professional membership in the Foundation, this should serve as a unique tool of communication. It is to that end that I intend to use it. However, no communication achieves its full potential unless it transmits a message that elicits a response. It is with that in mind that I invite readers of the NKF President’s Column to take the initiative to respond directly to me. After all, the strength of the Foundation is in its membership, and while the support they provide assumes many forms (financial contributions, voluntary service, advocacy of policies), one of the more precious of them is providing constructive criticism, novel ideas, and new programs. As such, one of my motivations in accepting the invitation of Neil Kurtzman is to establish a new two-way communication with the membership of the Foundation. In this first report, I would like to review three of the principal events of the past year that will impact the future activities of the Foundation. The one that temporally antecedes the other two, and has consumed more of my time over the past 3 years, is what can be considered a return of the Foundation to its roots of impacting directly American
Journal
of Kidney
Diseases,
Vol 29,
No 6 (June),
diligently to review the literature and develop rigorous and evidence-based clinical practice guidelines for the adequacy of hemodialysis and peritoneal dialysis, anemia, and vascular access. Their development has been one of the most cooperative, rewarding, and unifying efforts of the entire renal community. Together with Nathan Levin, I had the privilege of co-chairing the process. The guidelines are due for release in the spring of 1997. From the outset, the guidelines were intended only as a first step in attaining one goal: improved patient outcomes. Thus, it is their implementation that is the main goal of NKF-DOQI. Based on broad-based input, three types of activities are planned for the next 3 years to achieve this end: translating the recommendations into practice 1997:
pp xxxix-xl
xxxix
XI
through a series of core educational programs and tools; promoting a commitment to reduce practice variation by working with providers and insurers to adopt the guidelines; and developing performance measures to evaluate and assess compliance in an effort to validate and improve the guidelines over time. The spirit of cooperation and exemplary volunteerism that has gone into development of these guidelines has been a unique and rewarding experience. It is only this spirit and commitment that will help NKF-DOQI in its goal to place quality improvement directly into clinical practice. Your individual input, support, and efforts are absolutely essential to the success of this worthwhile goal. The second change I would like to mention is that of the founding of the Council of American Kidney Societies (CAKS) in 1996. The need for various organizations concerned with kidney and urologic diseases to present a unified front both on the Hill and the National Institutes of Health Campus led to establishment of the Intersociety Council. Because of the rather varied needs of the broad constituency of the Intersociety Council, CAKS was founded to strengthen and focus more directly on the needs of the renal community. It is composed of five sister renal organizations: American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplant Physicians, Renal Physicians Association, and the NKF, each represented by its current president. The stated purpose of CAKS is to “serve as a representative body of scientific and professional practice organizations in the promotion and support of clinical and basic research in the broad field of kidney diseases, in promotion and support of the practice of the broad field of adult and pediatric nephrology, and in promotion and support of the policies which affect the broad field of kidney diseases.” The CAKS has just begun to work toward that purpose. To this end, it has adopted a research and training agenda that was shared with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and presented to the National Institutes of Health Director, Harold Varmus; it has met with the leadership of the American College of Physicians asking for ear-
lier input and a voice in its activities as they pertain to the subspecialty of nephrology; it has nominated and supported the appointment of Barbara Hayes to the NIDDK Advisory Council; and it is in communication with the NIDDK for input into research priorities and future clinical trials. At the legislative level, a Congressional Breakfast and Day on the Hill is planned for April 15,1997. With such a start, CAKS is bound to have a promising future. The third change is an agreement with the American Society of Nephrology to merge in the presentation of a single Fall Scientific Program, beginning this year. The NKF will be represented by three members on the lo-member Program Committee, and will provide direct input through its Scientific Councils. The vice-chair of the Program Committee will be appointed by the NKF. For the 1997 Program Committee this is Jacques Bourgoignie; for 1998, it will be Manuel Martinez-Maldonado. From the NKF perspective, this will not only strengthen the Fall Scientific Meetings it had inaugurated and traditionally organized, but will also allow it to better focus on the Annual Spring Clinical Nephrology Meetings. When the Spring Clinical Nephrology Meetings were launched in 1993, the intent was twofold. First, to provide an alternative to the fall program since clinical demands require coverage and precluded everyone from attending a nephrology CME program annually. The second was to provide greater focus on clinical problems. The agreement with the American Society of Nephrology now allows for the NKF to concentrate more of its efforts on the Spring Clinical Nephrology Meetings. Donald Wesson will chair the 1998 program, and William Keane will serve as chair in 1999. They have the challenge to elevate the spring meetings to new and higher levels of achievement. I am personally grateful for their accepting this challenge. I invite all of you to attend these meetings and to determine whether they have met the challenge. In closing, I would again like to reiterate my request for your input in any and all matters that pertain to the NKF. I need your ideas, criticisms, and suggestions. It is only with your input and support that the NKF can maintain the growth and success it has achieved in the past.