title: ESRD care within the US Department of Veterans Affairs: a forward-looking program with an illuminating past.
abstract: The first governmental agency to provide maintenance hemodialysis to patients with end-stage renal disease (ESRD) was the Veterans Administration (VA; now the US Department of Veterans Affairs). Many historical VA policies and programs set the stage for the later care of both veteran and civilian patients with ESRD. More recent VA initiatives that target restructuring of care models based on quality management, system-wide payment policies to promote cost-effective dialysis, and innovation grants aim to improve contemporary care. The VA currently supports an expanded and diversified nationwide treatment program for patients with ESRD using an integrated patient-centered care paradigm. This narrative review of ESRD care by the VA explores not only the medical advances, but also the historical, socioeconomic, ethical, and political forces related to the care of veterans with ESRD.
authors: Portland VA Medical Center and Oregon Health and Sciences University, Portland, OR. Electronic address: suzanne.watnick@va.gov.
authors: Suzanne
authors: S
authors: Watnick
authors: VA Connecticut Healthcare System, West Haven, and Yale University School of Medicine, New Haven, CT.
authors: Susan T
authors: ST
authors: Crowley
mesh_terms: D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D018802:Patient-Centered Care / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: End-stage renal disease; US Department of Veterans Affairs; public policy