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Quality of care for dialysis patients: National initiative focuses on improved treatment
QUALITY OFCAREFORDIALYSISPATIENTS:
NATIONAL INITIATIVE FOCUSES
ON
IMPROVEDTREATMENT Sarah F. Zarbock,
PA-C
The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) is a groundbreaking project established to develop evidence-based dialysis treatment guidelines. Highlights of the guidelines were presented to the renal community in November 1996 at the National Kidney Foundation’s Annual Scientific Meeting in New Orleans.
These practice guidelines ultimately will improve the quality of life for the 200,000 patients on dialysis in the United States and were developed in response to the renal care community’s increasing concern over high rates of mortality and morbidity among such patients.
the issues most relevant to the improvement of patient survival, patient morbidity, efficiency of care, and quality of life, distilled the guidelines from extensive literature searches, relevant clinical study reports, and the clinical judgment of the work group members.”
The new initiative, considered a model for developing quality outcomes, represents an unprecedented level of cooperation and commitment by the entire renal community to improve the quality of care provided to patients on dialysis, according to NKF-DOQI chairman Nathan Levin, MD, chief of nephrology and hypertension at Beth Israel Medical Center in New York and professor of medicine at Albert Einstein College of Medicine.
The four areas identified for guideline development were vascular access, peritoneal dialysis adequacy, hemodialysis adequacy, and anemia (see box). Computerized searches of relevant literature yielded more than 11,000 articles, which were screened for relevance to the guidelines by NKF-DOQI group members. More than 3500 of the articles underwent formal structured review. Work groups then drafted guidelines based on the available evidence and on expert opinion in cases for which sufficient data were not available.
“The guideline-drafting process involved a highly focused effort by four independent work groups, each made up of a chairperson and approximately I 0 experts from diverse clinical disciplines,” Levin said. “The work groups, targeting
62 HOME
CARE PROVIDER
Drafts of the guidelines currently are undergoing external peer review by more than 500 professionals and patients
APRIL 1997, VOL. 2 NO. 2
SHARING
IN ALL DIMENSIONS
identified by organizations involved in some aspect of dialysis. Active in the guidelines review process are experts from dialysis providers; industry, managed care; government agencies, such as the Health Care Financing Administration; End Stage Renal Disease Networks; other patient care professionals; and patients. The public comment period ended in February I 997, and the final guidelines are scheduled for publication in April. The NKF-DOQI Advisory Council, an interdisciplinary body of 3 3 renal professionals, including nurses, social workers, pharmacists, physicians, scientists, and patients, already has reviewed the draft guidelines. The council commended the work groups for achieving their goal of drafting guidelines that reflect the broad needs of the dialysis community. The council also provided substantive comments and recommended ways to advance dissemination, acceptance, and use of the guidelines in clinical practice. “This unique outside professional review process serves to ensure that everyone within the renal community has an opportunity to contribute to the final product, which will help maximize acceptance and use of the final guidelines,” said Levin.
the draft guidelines was specifically designed to help ensure the guidelines are used by the renal care community for a greater impact on dialysis patient outcomes,” said Garabed Eknoyan, MD, vice president of NKF, NKF-DOQI cochairman, and professor of medicine at Baylor College of Medicine. “Our goal was not to produce guidelines that would sit on a shelf but ones that would become active and valued resources used by dialysis health care professionals to improve the quality of treatment.” Nearly 20 million Americans suffer from kidney and urologic diseases. The NKF is the nation’s largest voluntary health organization dedicated to the prevention, treatment, and ultimate cure of kidney diseases. The NKF brings help and hope to millions across America through programs in research, patient services, public information, professional education, and organ donation. The DOQI is one of the NKF’s most important national efforts to collaborate with both health care professionals and patients to improve the quality of life for those on chronic renal dialysis. For more information, contact Diane Goetz, Director of Communications, National Kidney Foundation, 30 East 33rd Street, New York, NY 10016; l-800-622-9010.
THE ROLE OF NUTRITION Renal care experts in recent years also have begun to recognize nutrition as an important aspect of successful dialysis treatment. The NKF-DOQI recently commissioned a fifth work group to focus on issues related to nutrition in patients on dialysis. This work group is charged with addressing the strength of relevant literature, determining the feasibility of issuing clinical practice guidelines, and identifying areas for further research. “The systematic,
evidence-based
APRIL 1997, VOL. 2 NO. 2
approach
used to produce
HOME
CARE PROVIDER
63
NATIONAL INITIATIVE FOCUSES
ON
IMPROVEDTREATMENT Sarah F. Zarbock,
PA-C
The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) is a groundbreaking project established to develop evidence-based dialysis treatment guidelines. Highlights of the guidelines were presented to the renal community in November 1996 at the National Kidney Foundation’s Annual Scientific Meeting in New Orleans.
These practice guidelines ultimately will improve the quality of life for the 200,000 patients on dialysis in the United States and were developed in response to the renal care community’s increasing concern over high rates of mortality and morbidity among such patients.
the issues most relevant to the improvement of patient survival, patient morbidity, efficiency of care, and quality of life, distilled the guidelines from extensive literature searches, relevant clinical study reports, and the clinical judgment of the work group members.”
The new initiative, considered a model for developing quality outcomes, represents an unprecedented level of cooperation and commitment by the entire renal community to improve the quality of care provided to patients on dialysis, according to NKF-DOQI chairman Nathan Levin, MD, chief of nephrology and hypertension at Beth Israel Medical Center in New York and professor of medicine at Albert Einstein College of Medicine.
The four areas identified for guideline development were vascular access, peritoneal dialysis adequacy, hemodialysis adequacy, and anemia (see box). Computerized searches of relevant literature yielded more than 11,000 articles, which were screened for relevance to the guidelines by NKF-DOQI group members. More than 3500 of the articles underwent formal structured review. Work groups then drafted guidelines based on the available evidence and on expert opinion in cases for which sufficient data were not available.
“The guideline-drafting process involved a highly focused effort by four independent work groups, each made up of a chairperson and approximately I 0 experts from diverse clinical disciplines,” Levin said. “The work groups, targeting
62 HOME
CARE PROVIDER
Drafts of the guidelines currently are undergoing external peer review by more than 500 professionals and patients
APRIL 1997, VOL. 2 NO. 2
SHARING
IN ALL DIMENSIONS
identified by organizations involved in some aspect of dialysis. Active in the guidelines review process are experts from dialysis providers; industry, managed care; government agencies, such as the Health Care Financing Administration; End Stage Renal Disease Networks; other patient care professionals; and patients. The public comment period ended in February I 997, and the final guidelines are scheduled for publication in April. The NKF-DOQI Advisory Council, an interdisciplinary body of 3 3 renal professionals, including nurses, social workers, pharmacists, physicians, scientists, and patients, already has reviewed the draft guidelines. The council commended the work groups for achieving their goal of drafting guidelines that reflect the broad needs of the dialysis community. The council also provided substantive comments and recommended ways to advance dissemination, acceptance, and use of the guidelines in clinical practice. “This unique outside professional review process serves to ensure that everyone within the renal community has an opportunity to contribute to the final product, which will help maximize acceptance and use of the final guidelines,” said Levin.
the draft guidelines was specifically designed to help ensure the guidelines are used by the renal care community for a greater impact on dialysis patient outcomes,” said Garabed Eknoyan, MD, vice president of NKF, NKF-DOQI cochairman, and professor of medicine at Baylor College of Medicine. “Our goal was not to produce guidelines that would sit on a shelf but ones that would become active and valued resources used by dialysis health care professionals to improve the quality of treatment.” Nearly 20 million Americans suffer from kidney and urologic diseases. The NKF is the nation’s largest voluntary health organization dedicated to the prevention, treatment, and ultimate cure of kidney diseases. The NKF brings help and hope to millions across America through programs in research, patient services, public information, professional education, and organ donation. The DOQI is one of the NKF’s most important national efforts to collaborate with both health care professionals and patients to improve the quality of life for those on chronic renal dialysis. For more information, contact Diane Goetz, Director of Communications, National Kidney Foundation, 30 East 33rd Street, New York, NY 10016; l-800-622-9010.
THE ROLE OF NUTRITION Renal care experts in recent years also have begun to recognize nutrition as an important aspect of successful dialysis treatment. The NKF-DOQI recently commissioned a fifth work group to focus on issues related to nutrition in patients on dialysis. This work group is charged with addressing the strength of relevant literature, determining the feasibility of issuing clinical practice guidelines, and identifying areas for further research. “The systematic,
evidence-based
APRIL 1997, VOL. 2 NO. 2
approach
used to produce
HOME
CARE PROVIDER
63