Measuring and managing health outcomes and quality of care in end-stage renal disease

Health outcomes measurement has become increasingly important in the care of patients with end-stage renal disease (ESRD). Interest has been stimulated by the relatively poor outcomes of patients with ESRD, variations in the process of care, the high costs of ESRD care, and the development of practice guidelines. There are a number of key outcome measures that can contribute to improving the care of patients with ESRD. Mortality, measured as the standardized mortality rate, remains a commonly used outcome measure. The standardized hospitalization rate is one measure of morbidity. Other important measures include: (i) transplantation rates; (ii) the proportion of patients with an appropriate hematocrit; (iii) the proportion of patients with usable vascular access at the initiation of hemodialysis; (iv) rates of vascular access failure: and (v) the mean urea reduction ratio. Quality-of-life measurement is becoming increasingly useful to providers of ESRD care. More experience is being gained with disease-specific quality-of-life instruments. Providers must be aware of the challenges that remain in health outcomes measurement and disease management. Resolving problems with case mix adjustment, managing the costs of measurement, extending Outcomes measurement to pre-ESRD care, and developing strategies to couple outcomes measurement with efforts to improve patient care are important goals.