Kidney failure and the federal government
| Autor principal: | |
|---|---|
| Autor Corporativo: | |
| Otros Autores: | , |
| Formato: | Libro electrónico |
| Idioma: | Inglés |
| Publicado: |
Washington, D.C. :
National Academy Press
1991.
|
| Edición: | 1st ed |
| Materias: | |
| Ver en Biblioteca Universitat Ramon Llull: | https://discovery.url.edu/permalink/34CSUC_URL/1im36ta/alma991009820323706719 |
Tabla de Contenidos:
- Kidney Failure and the Federal Government
- Copyright
- Acknowledgments
- Contents
- PART I Overview
- Summary
- THE CONGRESSIONAL CHARGE TO THE INSTITUTE OF MEDICINE
- BASIC ASSUMPTIONS
- ESRD PATIENTS AND THEIR TREATMENT
- ACCESS
- ETHICS
- THE PROVIDER COMMUNITY
- REIMBURSEMENT AND QUALITY
- Reimbursement Effects on Quality
- Outpatient Dialysis Reimbursement Issues
- Covered Services
- Rate-Setting and Payment Policy
- QUALITY ASSESSMENT AND ASSURANCE
- DATA SYSTEMS
- RESEARCH
- NOTES
- REFERENCES
- 1 Introduction
- THE CONGRESSIONAL CHARGE
- BASIC ASSUMPTIONS
- CONTEXT OF THIS STUDY
- STUDY METHODS
- THE ESRD PATIENT POPULATION
- NATIONAL EXPENDITURES FOR ESRD
- ORGANIZATION OF THE REPORT
- NOTES
- REFERENCES
- PART II Patients and Providers
- 2 Perspectives of ESRD Patients
- EXPERIENCES WITH RENAL FAILURE
- Patient Relationships with Physicians and Staff
- Patient Education
- Patient-Related Services
- Effect of Erythropoietin
- ECONOMIC EFFECTS OF KIDNEY FAILURE
- CONCLUSIONS
- NOTE
- REFERENCE
- 3 Ethical Issues
- PATIENT ACCEPTANCE CRITERIA
- WITHDRAWAL FROM TREATMENT
- Guidelines
- Advance Directives
- TREATING THE PROBLEM PATIENT
- CONCLUSIONS AND RECOMMENDATIONS.
- NOTES
- REFERENCES
- 4 The Patient Population
- INCIDENCE AND PREVALENCE
- COMPOSITION OF THE ESRD POPULATION
- MORTALITY ISSUES
- Unadjusted Mortality
- Adjusted Mortality
- Subgroup Mortality
- STATE AND REGIONAL MORTALITY DATA
- CROSS-NATIONAL MORTALITY DATA
- PROJECTIONS TO THE YEAR 20006
- NOTES
- REFERENCES
- 5 The ESRD Patient Population: Special Groups
- PEDIATRIC PATIENTS
- ELDERLY ESRD PATIENTS
- DIABETIC PATIENTS
- HYPERTENSIVE PATIENTS
- Hypertension in the United States
- Relationship Between Hypertension and Hypertensive ESRD
- Epidemiology of ESRD Attributed to Hypertension.
- Intervention
- MINORITY PATIENTS
- CONCLUSION
- NOTES
- REFERENCES
- 6 Structure of the Provider Community
- OVERVIEW
- Outpatient Dialysis Facilities
- Kidney Transplant Centers
- Pediatric Facilities
- CHANGING STRUCTURE OF THE OUTPATIENT DIALYSIS COMMUNITY
- Hospital-Based Versus Independent Providers9
- Hospital-Based Providers
- Patients
- Independent Providers
- Outpatient Dialysis Facilities
- Not-For-Profit Versus For-Profit Providers11
- Not-For-Profit Providers
- For-Profit Providers
- Size of Outpatient Dialysis Facilities12
- Facility Ownership
- CONCLUSIONS
- NOTES
- REFERENCES
- PART III Access
- 7 Access Problems of ESRD Patients
- ESRD PATIENTS NOT ELIGIBLE FOR MEDICARE
- Who Are the Reported Noneligibles?
- Magnitude of the Problem
- Geographic Variations
- Payment Sources
- State Medicaid Programs
- State Kidney Programs
- Other ESRD Programs
- Conclusions and Recommendations
- MEDICARE-ELIGIBLE ESRD PATIENTS
- Pediatric Patients
- Elderly Patients
- Barriers to Access
- Information
- Insurance
- Transportation
- Rehabilitation Services
- Preventive Services
- STATE REGULATIONS
- Specific Limits to Access and Geographic Variations
- Implications of Regulations for Access and Quality
- NOTES
- REFERENCES
- 8 Access to Kidney Transplantation
- OVERVIEW
- THE MEDICARE KIDNEY TRANSPLANT BENEFIT
- DISTRIBUTION OF KIDNEY TRANSPLANTS
- SUPPLY OF DONOR ORGANS
- CONCLUSIONS AND RECOMMENDATIONS
- NOTES
- REFERENCES
- PART IV Reimbursement and Quality
- 9 Medicare ESRD Payment Policy
- KIDNEY TRANSPLANT SERVICES
- Renal Transplant Center Reimbursement
- Physician and Medication Reimbursement
- OUTPATIENT DIALYSIS SERVICES
- Facility Reimbursement
- Historical Overview
- Current Policy
- Special Provisions for Home Dialysis.
- Special Provisions for Recombinant Human Erythropoietin (EPO)
- Physician Reimbursement
- INPATIENT DIALYSIS SERVICES
- Hospital Reimbursement
- Physician Reimbursement
- NOTES
- REFERENCES
- 10 Reimbursement Effects on Quality
- EFFECTS OF REIMBURSEMENT ON MORTALITY
- Assessing the Effects of Reimbursement on Mortality
- EFFECTS OF REIMBURSEMENT ON HOSPITALIZATION
- EFFECTS OF REIMBURSEMENT ON UNIT STAFFING
- What Factors Are Causing These Changes?
- What Are the Consequences of These Staffing Changes?
- Nurses
- Technicians
- Social Workers
- Dietitians
- Implications of Changing Staff Patterns for Quality
- EFFECTS OF REIMBURSEMENT ON INNOVATION
- Hemodialysis
- Peritoneal Dialysis
- Dialysis Research Support
- SUMMARY
- CONCLUSIONS
- NOTES
- References
- 11 Outpatient Dialysis Reimbursement Issues
- COVERED SERVICES IN THE COMPOSITE RATE
- THE RATE-SETTING PROCESS
- Timeliness of Cost Data
- Sampling Versus the Universe
- Medicare Part A Cost Principles
- The Calculation of Cost per Treatment
- Oversight of the Rate-Setting Process
- FACILITY PAYMENT POLICY ISSUES
- Level of Payment
- Dual Composite Rate
- Rebasing and Updating
- Inflation (or Market Basket)
- Patient Complexity (Case Mix)
- Technological Advances and Productivity
- Methods for Rebasing and Updating
- Labor Portion of the Composite Rate
- PHYSICIAN PAYMENT POLICY ISSUES
- CONCLUSIONS AND RECOMMENDATIONS
- NOTES
- REFERENCES
- APPENDIX 1
- APPENDIX 2
- Dissenting View of C.R. Neu
- Note
- 12 Quality Assessment and Assurance
- PRINCIPLES OF QA
- THINKING ABOUT QUALITY
- Structure
- Process
- Outcomes
- Outcomes and Process and Structure
- Proximate Clinical Indicators
- Functional-and Health-Status Assessments
- Patient Satisfaction
- Quality of Life
- Adjustment for Patient Complexity.
- RESPONSIBILITIES OF FEDERAL AGENCIES
- Public Health Service
- Centers for Disease Control
- Food and Drug Administration
- National Institutes of Health
- Agency for Health Care Policy and Research
- Health Care Financing Administration
- Conditions of Coverage
- State Survey Process
- HSQB and the ESRD Networks
- Bureau of Policy Development
- Office of Research and Demonstrations
- Coordination Within HCFA
- Quality Assessment and Assurance Data Needs
- CONTINUOUS QUALITY IMPROVEMENT
- The Dialysis Facility: Practical Considerations
- Examples of ESRD Quality Assurance
- CONCLUSIONS AND RECOMMENDATIONS
- NOTES
- REFERENCES
- APPENDIX 1 QUALITY OF CARE IN ESRD: AN EXAMPLE OF A PROXIMATE CLINICAL INDICATOR
- Treating Anemia in Dialysis Patients1
- Potential Use as an Outcome Indicator
- Potential Use as Process Indicators
- NOTE
- References
- APPENDIX 2 EXAMPLES OF ESRD QUALITY ASSURANCE
- Dialysis Clinic, Inc., Cincinnati (DCI-C)
- Greenfield Health Systems
- National Medical Care, Inc. (NMC)
- Reference
- PART V Data And Research
- 13 Data Systems
- HEALTH CARE FINANCING ADMINISTRATION
- U.S. RENAL DATA SYSTEM
- UNITED NETWORK FOR ORGAN SHARING
- NATIONAL END-STAGE RENAL DISEASE REGISTRY
- ADEQUACY OF DATA SYSTEMS
- RECOMMENDATIONS
- NOTES
- REFERENCES
- 14 Research Needs
- REFERENCES
- APPENDIXES
- A Glossary
- B Acronyms and Initialisms
- C Commissioned Papers and Contractor Reports
- Intergovernmental Health Policy Project, George Washington University
- Medical Media Associates, Inc.
- Urban Institute
- D Survival Analysis Methods for the End-Stage Renal Disease (ESRD) Program of Medicare
- GENERAL ISSUES IN SURVIVAL ANALYSIS
- Overview
- Examples
- Identification of the Study Population
- The Importance of a Comparison Group
- Biased Comparisons.
- Interpreting Standard Errors for Population Data
- Accounting for Random Variation
- Important Versus Significant
- Analysis of Provider Versus Patient
- Choice of Parameter for Mortality Summaries
- Type I and Type II Error Issues
- Projections and Extrapolations
- Accuracy of Counts
- ADJUSTING MORTALITY ANALYSES FOR PATIENT CHARACTERISTICS
- Patient Characteristics Related to Mortality
- Currently Available Data
- Unavailable or Difficult-to-Evaluate Data
- Multivariable Methods
- Stratification
- Modeling
- Simultaneous Effects of Variables
- Constraints on the Adjustment Process
- STATISTICAL METHODS OF ANALYSIS FOR ESRD MORTALITY DATA
- Descriptive Parameters for One Group
- Death Proportions
- Death Rates
- Survival Curves
- Expected Lifetimes
- Comparative Parameters
- Regression Models
- Specific Models and Methods
- Poisson Regression for Death Rates
- Cox Models for Relative Rates and Survival Functions
- Logistic Regression for the Probability of Death
- Conditional Logistic Regression and Sampling from the Risk Set
- Fully Parametric Models
- Prevalent Versus Incident Cohort Analyses
- Frailty
- Treatment Modality
- Publication of Standard Death Rates
- Institutional Characteristics
- Internal and External Standardization
- INTERNATIONAL COMPARISONS
- Limitations
- Etiology
- Age
- Withdrawal Rates
- Patient Follow-up
- Directions for Further Research
- REFERENCES
- E Institute of Medicine ESRD Study Committee Public Hearing, May 5, 1989, Chicago, Illinois
- List of Participants
- F Institute of Medicine ESRD Study Committee Public Hearing on ''Issues in Dialysis Reimbursement Reimbursement Rate-Setting
- List of Participants
- G Institute of Medicine ESRD Study Committee Workshop on ESRD Staffing, November 3, 1989, Washington, D.C.
- List of Participants.
- H Institute of Medicine ESRD Study Committee Workshop on Kidney Transplantation, December 13, 1989, Washington, D.C.
