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Introduction to Health Services Research : A Self-Study Course
Case Description | Case Background | Case Objectives | Case Exercise
Case 2. The End-Stage Renal Disease Program: Quality Issues (Page 7 of 34)
Phase One: Thinking About the Issues
Q2. How would you design a study to evaluate the quality of care dialysis patients receive?
Suggested Solution
You might wish to examine completed research studies that you retrieved in your searches.
Clinical investigators and health services researchers have conducted numerous studies to evaluate the quality of care dialysis patients receive. Renal specialists have developed indicators of successful outcomes of dialysis, such as hematocrit levels to assess anemia and urea-reduction rates to determine the amount of waste removed from the blood.
Health services researchers track mortality rates of ESRD patients and compare them to kidney patients in other countries. Multiple physical characteristics, such as co-existing conditions, nutritional status, and age, influence the quality of life for a person undergoing dialysis (Rettig, 1994; Levinsky, 1994).
Social and economic factors also contribute to their quality of life. People without adequate social support, funds, or transportation have a more difficult time maintaining a dialysis schedule, sustaining adequate nutrition, or purchasing necessary medications.
The New York Times published reports on the quality of care provided in U.S. dialysis facilities. These articles as well as others published in the medical literature (Derrick, 1995) demonstrate a lower level of care in the for-profit facilities.
For example, managers at these centers provided shorter dialysis sessions, reused equipment (tubing) that should be replaced, maintained out-dated equipment, and employed personnel with inadequate training (Eichenwald, 1995; Klahr, 1996). With the increase in for-profit health care systems and federal downsizing, the issues of profit maximization and government oversight generate concern among the patients, families, and caregivers in the End-Stage Renal Disease Program.
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