April 5, 2005 - The Agency for Healthcare Research and Quality (AHRQ) has released its second annual National Healthcare Quality report on behalf of the U.S. Department of Health and Human Services. This second report extends the baseline established in the 2003 report for a set of health care quality measures across four dimensions of quality - effectiveness, safety, timeliness, and patient centeredness - and, within the effectiveness component, nine clinical condition areas or care settings - cancer, diabetes, end stage renal disease, heart disease, HIV/AIDS, maternal and child health, mental health, respiratory diseases, and nursing home and home health care. The purpose of the report is to track the state of health care quality for the Nation on an annual basis. Press release from AHRQ.

See the State Summary Tables for five selected meaures related to End-Stage Renal Disease over two different time periods.

The Quality Challenge. Speech by Carolyn M. Clancy, at the Health Care Quality Summit�Improving Health Care for All Americans, Washington, DC, April 4, 2005. Agency for Healthcare Research and Quality, Rockville, MD.

Highlights of Chapter Two:

End-Stage Renal Disease

Importance and Measures

End stage renal disease (ESRD) is the complete or nearly complete shutdown of kidney functions requiring lifetime renal replacement therapy (either dialysis or kidney transplantation).

Prevalence and Incidence

• Over 400,000 people have ESRD in the United States.
  
• Almost 100,000 new ESRD patients begin renal replacement therapy each year, and the disease is on the rise.
  
• It is estimated that by 2030, there will be approximately 2.2 million ESRD patients in the Nation.
  
• Diabetes is the most common cause of ESRD, and it is expected to surpass all other causes combined in terms of ESRD incidence by 2006 and of ESRD prevalence by 2018.
  

Morbidity and Mortality

• Without treatment, ESRD is fatal. Even with dialysis treatment, 20% of ESRD patients die yearly.
  
• Most ESRD patients are on hemodialysis at a dialysis center 3 days a week, which seriously affects their quality of life.
  

Cost

• Expenditures for ESRD totaled almost $23 billion in 2001 (Medicare and non-Medicare).
  
• According to the Medicare program, ESRD expenditures totaled over $15 billion, 6.4% of the totalMedicare budget in 2001.
  

Measures

• The NHQR includes six measures to assess the quality of care provided to renal dialysis patients. Two measures are highlighted in this section:
  
• Adequacy of hemodialysis, as measured by patient�s urea reduction ratio (URR)
  
• Percent of hemodialysis patients using arteriovenous fistulas (AVFs) for vascular access