The medical director in integrated clinical care models.

Integrated clinical care models, like Accountable Care Organizations and ESRD Seamless Care Organizations, present new opportunities for dialysis facility medical directors to affect changes in care that result in improved patient outcomes. Currently, there is little scholarly information on what role the medical director should play. In this opinion-based review, it is predicted that dialysis providers, the hospitals in which the medical director and staff physicians practice, and the payers with which they contract are going to insist that, as care becomes more integrated, dialysis facility medical directors participate in new ways to improve quality and decrease the costs of care.

Guiding principles and checklist for population-based quality metrics.

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery.

Dialysis at a crossroads--Part II: A call for action.

A previous commentary pointed out that the renal community has led American healthcare in the development and continuous improvement of quality outcomes. However, survival, hospitalization, and quality of life for US dialysis patients is still not optimal. This follow-up commentary examines the obstacles, gaps, and metrics that characterize this unfortunate state of affairs.

The chronic kidney disease initiative.

The Chronic Kidney Disease Initiative was implemented at the request of the Council of American Kidney Societies to formulate a plan of action to solve many of the perceived problems associated with identifying, caring for, and attaining the best outcomes for patients with chronic kidney disease. With the assistance of a community of stakeholders and a formalized workshop and process, the Chronic Kidney Disease Initiative identified the barriers to solving this complicated problem. Barriers were given hierarchical significance, and solutions and action plans to the barriers were formulated.

Report of the International Society of Nephrology: North American Renal Disaster Response Task Force.

This article comprises a report from the North American Renal Disaster Response Task Force (RDRTF) set up in 2001 by the International Society of Nephrology Acute Renal Failure Commission. The conclusions of the report are (1) given the rarity of renal disasters in the Americas the North American and Latin American RDRTF's should be merged; (2) for the same reason, a single RDRFT Coordination Center for the whole world should be established and it is suggested that this be in Ghent, Belgium; (3) the collaborative group set up in Europe and involving the European RDRTF and Medecins Sans Frontiers be asked to extend their rapid response service to cover acute renal disasters in the Americas south of the United States-Mexico border; (4) the combined RDRTF for the Americas should establish a list of nephrologists, nurses, and technicians who are available to assist in the acute response to renal disasters; (5) the combined RDRTF of the Americas establish an inventory of equipment, machines, and methods for their transport that would be available in the event of a disaster; and (6) the RDRTF of the Americas should undertake a large-scale educational initiative on management of renal disasters.

L-carnitine use in dialysis patients: is national coverage for supplementation justified? What were CMS regulators thinking--or were they?

Careful review of all available clinical trials of L-carnitine leads to the conclusion that there is insufficient evidence to support the routine use of L-carnitine for any indication in dialysis patients. The literature suffers from a lack of adequately designed studies, and many of the studies which supposedly justify payment for L-carnitine supplementation are more than 10 years old. While some studies support a subjective improvement in symptoms after a few months of L-carnitine treatment, there is little confirming objective data.