title: Challenges and barriers to managing quality in an end-stage renal disease facility.
abstract: The End-Stage Renal Disease Program is underfunded and overregulated. Objective parameters of end points of care do not correlate to specific clinical practice patterns. We do not have consensus between payers, providers, and patients as to what the objectives of the End-Stage Renal Disease Program are or should be. This report will address the need for an integrated health care delivery system that would benefit the end-stage renal disease patient and the barriers to designing such a system. The quality improvement program of a five-unit dialysis system will be described. The deficiencies of the quality improvement program and the limitation of the facilities to improve outcome will be discussed, and constructive alternatives to achieve an integrated health care delivery system that promotes improvement in patient outcomes will be suggested.
authors.affiliation: Division of Nephrology, Lankenau Hospital/Lankenau Medical Research Center, Wynnewood, PA.
authors.forename: D
authors.initials: D
authors.lastname: VanValkenburgh
authors.forename: S
authors.initials: S
authors.lastname: Snyder
mesh_terms: D006436:Hemodialysis Units, Hospital / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D006278:Medicare; D010561:Personnel Staffing and Scheduling; D015143:Philadelphia; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*; D011788:Quality of Life; D012052:Reimbursement, Incentive; D006435:Renal Dialysis / Q000191:economics / Q000592:standards*; D013192:Staff Development; D016896:Treatment Outcome; D014481:United States