Kidney Patient-Centered Quality of Care, Part I: The Healthcare Quality Environment

Series Introduction

To understand how we think about quality in the delivery of end stage renal disease (ESRD) care and how we successfully implement programs that drive quality, it is important, as Stephen Covey urged, to “begin with the end in mind.” This kidney patient-centered quality of care series will cover the following topics:

1. The healthcare quality environment
2. Approaches to quality for ESRD patients
3. The key participants who contribute to the success of quality programs
4. Future approaches to delivering care to kidney patients that can reinforce how we advance quality of life for this vulnerable patient population

Underlying these is the concept that all we do in dialysis care should be about the patients—we need to focus on what our patients need, and ensure that patients and their families are educated about their disease and its treatment, and are fully involved in decisions about treatment options. Patients’ needs must be self-defined in order to optimize individualized care. In addition, it can be beneficial for the care team to ultimately focus on adding moments to patients’ lives (such as moments with friends, family and doing what they love) rather than merely achieving metric goals. Connecting with patients on this human level can motivate the care team to go the extra mile for their patients and give the best care possible.

The Healthcare Quality Environment

Many theoretical frameworks for quality of care have been developed in the public domain, including the following:

• The National Quality Strategy (developed by the Agency for Healthcare Research and Quality): Focuses nationwide attention on quality improvement and measurement.
• The Healthcare Triple Aim: Intends to improve the health of populations, to enhance the experience of care and to constrain the costs of care.
• The Centers for Medicare & Medicaid Quality Strategy: Aims to reduce harm in care delivery, strengthen care engagement, improve communication and coordination of care, effectively prevent and treat chronic disease, improve community health and make care affordable.
• The National Quality Forum: Sets relevant domains for quality, including advanced care planning, adverse drug events, avoidable admissions, infection rates and transition planning.
• Kidney Care Partners: Defines key quality domains for ESRD patients through a quality blueprint.

How do we organize these ideas, prioritize what is truly important and focus attention and resources in those areas with the greatest impact optimizing patient outcomes? The latter point is of particular importance and is clearly challenging. While there is widespread recognition of the areas of clinical focus that are most likely to improve survival, morbidity, the patient experience and overall quality of life, the ability of providers to deliver on these areas has been stymied by:

• The lack of a unified conceptual framework for quality for ESRD patients and
• The need to coordinate care for a complex, fragile, patient population in a fee-for-service payment environment with shrinking resources.

We must resolve which areas of care are most important, determine how to measure these reliably and reproducible and make the results available in real time so that they can inform quality improvement efforts. We must also work with payers to create innovative care delivery and payment models that enable care coordination and truly drive holistic, patient-centric care. The following blog post will review the DaVita Patient-Focused Quality Pyramid, which provides a conceptual framework of hierarchical key clinical targets and metrics that ultimately can improve the quality of life for patients with kidney disease.

Upcoming post: Part II: A Quality Framework for ESRD Patients

Some of the content of this post has been previously published. Source: Delivering Better Quality of Care: Relentless Focus and Starting with the End in Mind at DaVita. Allen R. Nissenson, MD. Seminars in Dialysis, Volume 29, Issue 2. © 2016. Publisher: Wiley-Blackwell. [Link to original article].