Efforts to Improve Patient Care Outcomes Continue at a Strong Pace
Sally D. McCulloch
The enormous effort to improve patient care outcomes in persons with ESRD by the development and publication of the DOQI (National Kidney Foundation – Dialysis Outcomes Quality Initiative) guidelines lives on. The publications are intended to be living documents and as such are updated using the same rigorous process used in producing the initial set of guidelines. Information and educational materials for health care providers and the public are readily available on the NKF web site at www.kidney.org
Focus of the New Effort
The new effort is to improve outcomes in the estimated 3 million-plus individuals who have early kidney disease or are at high risk for developing kidney disease. To reflect this broadened focus, the word dialysis — which implies an end stage, irreversible, disease state — has been changed to the word disease, which may or may not progress to end stage, hence the new name, K/DOQI or Kidney Disease Outcomes Quality Initiative. The hope of the new effort is to prevent and/or slow progression of the disease before it gets to the point of end stage and change the thinking that end stage disease is inevitable in persons with early insufficiency.
The health care providers seeing patients in the early stages of renal insufficiency will be key to this initiative’s success. They will be in charge of educating the general public, particularly persons at risk because of other problems such as diabetes or hypertension. Part of that education is avoiding words like “renal” and “end stage,” and focusing the discussion plainly on kidney disease. This brings back a humorous incident that occurred to me when I went into a convenience store on my way to work as a renal transplant head nurse years ago, and the clerk looked at my name tag and asked, “What’s a renal?” Now, this makes sense!
Guidelines Geared to Various Providers
The new guidelines, which will be developed into implementation tools, will be geared not only to nephrology health care providers, but to our colleagues in specialties most likely to encounter those at risk for kidney disease early in the course of their illness. These would include family practice, pediatric, internal medicine, and women’s health care providers. As nephrology nurses, let’s make certain that we do our part in seeing that these new guidelines are implemented successfully. We can and must play an important educational part in this enlarged scope of preventing and slowing progression in kidney disease before it reaches end stage.
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