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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Case 2. The End-Stage Renal Disease Program: Quality Issues (Page 2 of 34)

Overview and Background

End-stage kidney disease is "a complete or near complete failure of the kidneys to function to excrete wastes, concentrate urine, and regulate electrolytes. Also called End-stage renal disease (ESRD)."

The MedlinePlus Medical Encyclopedia goes on to describe the causes, incidence, and risk factors this way:

"End-stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day to day life. It usually occurs as chronic renal failure progresses to the point where kidney function is less than 10% of baseline. At this point, the kidney function is so low that without dialysis or kidney transplantation, complications are multiple and severe, and death will occur from accumulation of fluids and waste products in the body.

In the United States, nearly 300,000 people are on long-term dialysis and more than 20,000 have a functioning transplanted kidney. The most common cause of ESRD in the US is diabetes. ESRD almost always follows chronic renal failure, which may exist for 10 to 20 years or more before progression to ESRD."

With over 300,000 people with ESRD receiving free and universal access to care it is important to make sure that not only is access to high quality care available but that it is also equitable. The poor and underserved often have social support, funding, or transportation issues to overcome in order to get dialysis on a regular schedule. With that the availability of food for adequate nutrition is a concern. Another issue is patients' ability to purchase necessary medications.

Eichenwald investigated this and related issues in his 1995 New York Times article titled, "Death and deficiency in kidney treatment" (Eichenwald, 1995).

Additionally, with so much going to pay for this program, it is important to know if the money is well spent. Klahr wrote about this topic in an article titled, " Anemia, dialysis, and dollars," in the New England Journal of Medicine in 1996 (Klahr, 1996).

Many with ESRD suffer from a reduced quality of life just by the nature of the disease. Another issue to examine is whether or not a patient's quality of life is good and that it is constantly checked (quality of care) (Levinsky, 1994 and Rettig, 1994).

Both quality of care in ESRD programs and quality of life issues are worth pursuing even though the program has been in operation since 1972.

Keeping people with ESRD healthy and productive members of society requires ESRD program oversight and concern with the health status of the individuals in the program.

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