The ESRD Quality Incentive Program: The Current Limitations of Evidence and Data to Develop Measures, Drive Improvement, and Incentivize Outcomes

This article describes the current state of facilitating the integration of evidence into practice to support initiatives focused on patients with ESRD. We will use the Centers for Medicare and Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) as an example, including a description of the health information infrastructure needed to support the translation of evidence into practice and some of the challenges encountered. The process from the generation of evidence to integration of this evidence into practice includes policy development leading to clinical practice guidelines, clinical performance measures, and clinical decision support tools. The ESRD QIP is the most mature program outside the hospital initiatives in the CMS Quality Payment Program and currently contains 16 measures. ESRD data to support these measures are aggregated at the dialysis facility level and reported through the CMS Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) and the Centers for Disease Control and Prevention using the National Healthcare Safety Network. We review these measures and the health information infrastructure used to report the data, focusing on the inherent strengths and weaknesses of the ESRD QIP along with opportunities for improvement of the program.