The importance of performance evaluation in implementation of the dialysis outcomes quality initiative guidelines

To determine the extent to which actual practices become more consistent over time with those advocated in Dialysis Outcomes Quality Initiative Guidelines, clinical performance measures (CPMs) that are based on the DOQI Guidelines will need to be developed and implemented. CPMs also can be used to evaluate the effectiveness of interventions that are undertaken to promote compliance with specific Guideline recommendations, to validate DOQI Guidelines that were based in whole or in part on expert opinion, and to protect against erosion of the quality of care delivered to end-stage renal disease patients that could occur as a result of economic pressures. To achieve these goals, CPMs must be valid, reliable, and practical to use. A federally sponsored effort to develop such CPMs is currently underway. This report presents an overview of CPMs and the challenges involved in developing technically sound specifications for CPMs that are based on DOQI guidelines.