Data management to understand outcomes and trends in ESRD.
Although a number of databases currently exist for the end-stage renal disease (ESRD) program in the United States, these databases are difficult to use to drive continuous quality improvement (CQI) activities at the ESRD provider level. The largest databases, such as the United States Renal Data System (USRDS) and the Medicare billing system, can generate facility-specific profiles for a limited set of parameters, but these parameters are not appropriately derived and validated clinical performance measures (CPMs) and the data on which they are based are 1 to 2 years old. The ESRD Core Indicators Project uses a sampling methodology to generate annual "snapshots" of the ESRD program but cannot generate facility-specific profiles to drive CQI. The ESRD Networks have the capability of collecting provider-specific data to drive CQI activities by generating profiles based on validated CPMs, but the Networks have been hampered in doing so by an aging data management infrastructure. The Standardized Information Management System (SIMS) and the Vital Information System for Outcomes Improvement in Nephrology (VISION) projects will provide the electronic highway for transmission of data from the Networks to the Health Care Financing Administration and from ESRD providers to the Networks, respectively. This will allow for paperless real time collection, validation, analysis, and management of quality of care data to drive CQI activities at the provider level. The Data Management and Analysis Proposal (DMAP) of the Forum of ESRD Networks recommends the establishment of a virtual service bureau to integrate all of the above ESRD databases to facilitate national and focused quality improvement projects, provide user-friendly database access for scholarly activities, and link financial and clinical data sets to generate cost-effectiveness analyses.
Wish
J B
JB
Department of Medicine, Case Western Reserve University, Cleveland, OH, USA. jaywish@earthlink.net
D014487:Centers for Medicare and Medicaid Services, U.S.; D019992:Databases as Topic; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008331:Management Information Systems; D009316:National Institutes of Health (U.S.); D017063:Outcome Assessment, Health Care; D014481:United States