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Multidisciplinary Dialogue Is Needed to Achieve Whole-Person Quality Measures for Dialysis Care

Sonia Rodriguez-Ramirez Sonia Rodriguez-Ramirez, MD, MScHQ, and Asad A. Merchant, MD, MScCH, FRCP(C), are assistant professors of medicine, and Istvan Mucsi, MD, PhD, FASN, is a professor of medicine with the Division of Nephrology and Ajmera Transplant Centre, University Health Network, and with the Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.

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Asad A. Merchant Sonia Rodriguez-Ramirez, MD, MScHQ, and Asad A. Merchant, MD, MScCH, FRCP(C), are assistant professors of medicine, and Istvan Mucsi, MD, PhD, FASN, is a professor of medicine with the Division of Nephrology and Ajmera Transplant Centre, University Health Network, and with the Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.

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Istvan Mucsi Sonia Rodriguez-Ramirez, MD, MScHQ, and Asad A. Merchant, MD, MScCH, FRCP(C), are assistant professors of medicine, and Istvan Mucsi, MD, PhD, FASN, is a professor of medicine with the Division of Nephrology and Ajmera Transplant Centre, University Health Network, and with the Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.

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A recent article summarizing outcomes from the 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care (1) explores the need for a more patient-centered dialysis quality system in alignment with the US Institute of Medicine Committee on Quality of Health Care in America describing it as: respectful of and responsive to individual patient preferences, needs, and values (2, 3). The authors, who were participants in the KDOQI workshop, suggest including patient priorities and life goals in dialysis quality systems. They also highlight current gaps, particularly in the End-Stage Renal Disease Quality Incentive Program, which focuses on biochemical and administrative outcomes but needs to capture patient-reported outcomes and experiences (1).

The proposal to incorporate a “life goal” quality measure is a notable innovation. The authors of the report (1) acknowledge potential conflicts between individualized care and population-level quality measures. To address this, ongoing dialogue between stakeholders and a periodic revision of goals and care strategies will be required (4, 5).

Another significant insight is the incorporation of social determinants of health into quality measures. However, data collection challenges, patient privacy, and the administrative burden on facilities are substantial. Although the workshop included a broad spectrum of stakeholders, perspectives from marginalized groups likely need better representation (6), which will require proactive outreach, intentional inclusion efforts, and mechanisms to amplify marginalized voices beyond consensus processes (7).

The recommendations for improving the collection and utilization of patient-reported data are particularly valuable. These recommendations can address the current issues of low response rates and delayed feedback and may want to include qualitative and narrative methods which may better capture the complexity and diversity of illness experiences (810).

In conclusion, the report provides a thorough and insightful critique of current dialysis quality measures, highlighting the need for a more patient-centered approach. However, it is worth noting that the systems described and approaches considered are unique to the US health care context. There is a clear tension between the quantitative, reductionist, and administrative perspective and the spirit of person- and community-centered, whole-person care. To build more person- and community-centered, whole-person care, we will require a flexible and dynamic quality system that balances the needs of individual patients with population health goals (Figure). To achieve this, an inclusive, participatory, interprofessional, and multidisciplinary dialogue will be needed, and inviting perspectives from other jurisdictions may be helpful.

Figure
Figure

Factors in a whole-person quality system for dialysis care

Citation: Kidney News 16, 10/11

Footnotes

The authors report no conflicts of interest.

References

  • 1.

    Weiner DE, et al.; KDOQI Patient-Centered Quality Measures for Dialysis Care Workshop Participants. Patient-Centered Quality Measures for Dialysis Care: A report of a Kidney Disease Outcomes Quality Initiative (KDOQI) scientific workshop sponsored by the National Kidney Foundation. Am J Kidney Dis 2024; 83:636647. doi: 10.1053/j.ajkd.2023.09.015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press (US); 2001.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Berwick DM. What “patient-centered” should mean: Confessions of an extremist. Health Aff (Millwood) 2009; 28:w555565. doi: 10.1377/hlthaff.28.4.w555

  • 4.

    Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med 2011; 9:100103. doi: 10.1370/afm.1239

  • 5.

    Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient-centered care. N Engl J Med 2012; 366:780781. doi: 10.1056/NEJMp1109283

  • 6.

    Rony M, et al. Perceptions of the healthcare system among Black men with previously undiagnosed diabetes and prediabetes. J Racial Ethn Health Disparities 2023; 10:31503158. doi: 10.1007/s40615-022-01488-z

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Rizzolo K, et al. Centering marginalized voices in advocacy for equitable policy change in kidney disease. Curr Opin Nephrol Hypertens (published online June 17, 2024). doi: 10.1097/MNH.0000000000001005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    O’Hare AM. Patient-centered care in renal medicine: Five strategies to meet the challenge. Am J Kidney Dis 2018; 71:732736. doi: 10.1053/j.ajkd.2017.11.022

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Luxford K, et al. Promoting patient-centered care: A qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. Int J Qual Health Care 2011; 23:510515. doi: 10.1093/intqhc/mzr024

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Montgomery T, et al. Transparency as a trust-building practice in physician relationships with patients. JAMA 2020; 324:23652366. doi: 10.1001/jama.2020.18368

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