PATIENTS VIEW OF DIALYSIS CARE - DEVELOPMENT OF A TAXONOMY AND RATINGOF IMPORTANCE OF DIFFERENT ASPECTS OF CARE

Quality assessment efforts to enhance public accountability in dialysi s care and to support provider efforts to improve care have lacked pat ient input. To develop brief patient evaluation or satisfaction survey s suitable for busy clinical settings, knowing patients' priorities ca n be helpful in deciding which aspects of care should be tracked. We c onducted a study to identify salient attributes of dialysis care and t o rank the importance of these attributes from the perspective of dial ysis patients. We analyzed the content of patient focus group transcri pts to characterize dialysis care from the patients' perspective. We t hen surveyed 86 patients to determine how patients would rank the impo rtance of each aspect to quality of dialysis care. The 18 broad aspect s of care identified in the focus group included: (1) care provided by nephrologists, (2) care provided by other physicians (nonnephrologist s), (3) care provided by dialysis center nurses, (4) care provided by social workers and psychologists, (5) care provided by dieticians, (6) clergy, (7) care provided by technicians and physician assistants/nur se practitioners, (8) care provided by dialysis center staff in genera l, (9) supplies, (10) treatment choice and effectiveness, (11) patient education and training, (12) self-care, (13) dialysis machines, (14) unit environment and policies, (15) cost containment, (16) billing, (1 7) cost of care, and (18) health outcomes. Items ranked in the top 10 by both groups of patients included issues related to nephrologists, o ther doctors, nurses, and patient education and training. Compared wit h hemodialysis patients, peritoneal dialysis patients gave higher rati ngs to hospital doctors' and nurses' attention to cleanliness when wor king with access sites, how correct the nephrologist's instructions to patients are, whether emergency room doctors check with nephrologists , the amount of information patients get about their diet, and how wel l nurses answer patients' questions. Patients value certain aspects of dialysis care highly, and these aspects differed in some respects for the relatively small number of hemodialysis and peritoneal dialysis p atients studied. Construction of brief questionnaires for quality asse ssment and assurance requires thoughtful consideration of what questio ns to include. Knowing patients' priorities regarding the most importa nt aspects of care that have high potential for dissatisfaction may be helpful to continuous quality improvement of end-stage renal disease care. (C) 1997 by the National Kidney Foundation, Inc.