title: Quality Measures for Dialysis: Time for a Balanced Scorecard.
abstract: Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care.
authors: Department of Medicine, Yale School of Medicine, Yale New Haven Health System, New Haven, Connecticut Alan.Kliger@ynhh.org.
authors: Alan S
authors: AS
authors: Kliger
mesh_terms: D022126:Access to Information; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D017064:Process Assessment, Health Care / Q000191:economics / Q000592:standards*; D058996:Quality Improvement / Q000191:economics / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards*; D012052:Reimbursement, Incentive; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D016896:Treatment Outcome
keywords: clinical performance measures; dialysis; quality of life