Changes in dialysis units' quality improvement practices from 1994 to 1996.

In 1994, the Health Care Financing Administration initiated a nationwide effort to improve care to Medicare's end stage renal disease (ESRD) beneficiaries by reshaping the manner in which the ESRD Network Organizations measure and assess the quality of dialysis services. The new approach was named the ESRD Health Care Quality Improvement Program (HCQIP). It embodies themes such as the development of quality indicators and support for continuous improvement. Projects such as the ESRD Core Indicators Project and the National Anemia Cooperative Project are geared toward assisting dialysis providers to improve patient care. In an effort to document changes in dialysis quality practices associated with the ESRD HCQIP, surveys were sent by Network staff to the head nurses of all dialysis units in 1994, and a random sample of units in 1996. Analysis of the survey responses was performed identifying self-reported changes in dialysis units' quality improvement activities. Results indicate that practice changes are taking place, that they are generalizable to all dialysis units in the country, and that they are associated with improvement in patient outcomes. Trends in quality improvement activities are identified and conclusions are drawn about what impact these activities have on patient care.