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Public Policy Series
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Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm

Allen R. Nissenson
CJASN February 2014, 9 (2) 430-434; DOI: https://doi.org/10.2215/CJN.05980613
Allen R. Nissenson
David Geffen School of Medicine, University of California, Los Angeles, California; and Chief Medical Officer, DaVita HealthCare Partners, Inc., Denver, Colorado
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    Figure 1.

    The patient-focused quality hierarchy (the “quality pyramid”). The individual boxes are examples within the key layers that form the pyramid and are not meant to encompass all possible items within a layer. What Matters Most–outcomes that improve patients' health related quality of life; Measures of Effectiveness–primary outcomes driven by lower complex programs and fundamental clinical areas of focus; Complex Programs-comprehensive and multi-faceted clinical programs driven by fundamental clinical areas of focus and closely linked to highest-order outcomes; The Fundamentals–basic clinical information focusing largely on biochemical and surrogate data. AVF, arteriovenous fistula; CVD, cardiovascular disease; CVC, central venous catheter; EOL, end of life; HRQOL, health related quality of life; MBD, mineral and bone disorder; Med, medical; mgmt, management; Pt., patient; PTH, parathyroid hormone; tx, treatment; URR, urea reduction ratio.

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Clinical Journal of the American Society of Nephrology: 9 (2)
Clinical Journal of the American Society of Nephrology
Vol. 9, Issue 2
February 07, 2014
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Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm
Allen R. Nissenson
CJASN Feb 2014, 9 (2) 430-434; DOI: 10.2215/CJN.05980613

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Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm
Allen R. Nissenson
CJASN Feb 2014, 9 (2) 430-434; DOI: 10.2215/CJN.05980613
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  • Article
    • Summary
    • Introduction
    • Patient-Focused Care
    • What Matters Most
    • Measures of Effectiveness
    • The Fundamentals
    • The Patient Hierarchy in Practice
    • Disclosures
    • Acknowledgments
    • Footnotes
    • References
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More in this TOC Section

  • New Organ Allocation System for Combined Liver-Kidney Transplants and the Availability of Kidneys for Transplant to Patients with Stage 4–5 CKD
  • Consolidation in the Dialysis Industry, Patient Choice, and Local Market Competition
  • New Opportunities for Funding Dialysis-Dependent Undocumented Individuals
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Cited By...

  • Measuring Quality in Kidney Care: An Evaluation of Existing Quality Metrics and Approach to Facilitating Improvements in Care Delivery
  • Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients
  • Advancing American Kidney Health: Perspective from DaVita, Inc.
  • Using patient-reported outcome measures (PROMs) to promote quality of care in the management of patients with established kidney disease requiring treatment with haemodialysis in the UK (PROM-HD): a qualitative study protocol
  • Building an Ideal Quality Metric for ESRD Health Care Delivery
  • The ESRD Quality Incentive Program--Can We Bridge the Chasm?
  • The Use of a Multidimensional Measure of Dialysis Adequacy--Moving beyond Small Solute Kinetics
  • Survival by Dialysis Modality--Who Cares?
  • Quality Measures for Dialysis: Time for a Balanced Scorecard
  • Medical Director Responsibilities to the ESRD Network
  • The Medical Director in Integrated Clinical Care Models
  • How the ESRD Quality Incentive Program Could Potentially Improve Quality of Life for Patients on Dialysis
  • The Medical Director and Quality Requirements in the Dialysis Facility
  • Advance Care Planning: A Qualitative Study of Dialysis Patients and Families
  • Performance Measures in Dialysis Facilities: What Is the Goal?
  • Guiding Principles and Checklist for Population-Based Quality Metrics
  • Patient satisfaction with in-centre haemodialysis care: an international survey
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