End-stage renal disease measures of quality

During the past 35 years, there has been a geometric expansion of the population of patients receiving chronic dialysis therapy in the United States. As the size and associated costs of the dialysis population have grown, there has been a consistent and evolving emphasis on measuring and improving the quality of dialysis care. These efforts, aided by robust data collection vehicles, have translated into defined clinical performance measures; nevertheless, morbidity and mortality rates remain high for the dialysis population. Recently, attention has focused on whether improved outcomes could be obtained by paying physicians and dialysis providers on the basis of quality metrics. The feasibility, value, pitfalls, and appropriate quality metrics in a "payment-for-quality" program for dialysis care are currently under vigorous discussion.