Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Jun 2014
Guiding principles and checklist for population-based quality metrics.
The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. ⋯ Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes.
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Clin J Am Soc Nephrol · Jun 2014
The association between peritoneal dialysis modality and peritonitis.
There is conflicting evidence comparing peritonitis rates among patients treated with continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). This study aims to clarify the relationship between peritoneal dialysis (PD) modality (APD versus CAPD) and the risk of developing PD-associated peritonitis. ⋯ PD modality was not associated with a higher likelihood of developing peritonitis. However, APD was associated with a borderline reduction in the likelihood of a first episode of Gram-positive peritonitis compared with CAPD, and with lower rates of culture-negative peritonitis and higher rates of Gram-negative peritonitis. Peritonitis outcomes were comparable between both modalities.
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Clin J Am Soc Nephrol · Jun 2014
Evaluation of the consumer assessment of healthcare providers and systems in-center hemodialysis survey.
The US Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Prospective Payment System and Quality Incentive Program requires that dialysis centers meet predefined criteria for quality of patient care to ensure future funding. The CMS selected the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis (CAHPS-ICH) survey for the assessment of patient experience of care. This analysis evaluated the psychometric properties of the CAHPS-ICH survey in a sample of hemodialysis patients. ⋯ CAHPS-ICH is a potentially valuable and informative tool for the evaluation of patients' experiences with dialysis care. Additional studies are needed to estimate clinically meaningful differences between care providers.
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Clin J Am Soc Nephrol · Jun 2014
Comparative Study Observational StudyEpidemiology and outcomes in community-acquired versus hospital-acquired AKI.
Compared with AKI in hospitalized patients, little is known about patients sustaining AKI in the community and how this differs from AKI in hospital. This study compared epidemiology, risk factors, and short- and long-term outcomes for patients with community-acquired (CA) and hospital-acquired (HA) AKI. ⋯ Patients with CA-AKI sustain more severe AKI than patients with HA-AKI. Despite having risk factors similar to those of patients with HA-AKI, patients with CA AKI have better short- and long-term outcomes.
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Clin J Am Soc Nephrol · May 2014
Randomized Controlled TrialLow-dose rapamycin (sirolimus) effects in autosomal dominant polycystic kidney disease: an open-label randomized controlled pilot study.
The two largest studies of mammalian target of rapamycin inhibitor treatment of autosomal dominant polycystic kidney disease (ADPKD) demonstrated no clear benefit on the primary endpoint of total kidney volume (TKV) or on eGFR. The present study evaluated two levels of rapamycin on the 12-month change in (125)I-iothalamate GFR (iGFR) as the primary endpoint and TKV secondarily. ⋯ Patients with ADPKD receiving LD rapamycin demonstrated a significant increase in iGFR compared with those receiving standard care, without a significant effect on TKV after 12 months.