Italian Society of Nephrology "Quality & Accreditation” Committee

 

Presentation

 

During the past few years The Italian Society of Nephrology has focused its attention to   improve the technical-scientific and organizational aspects of this service , as well as better patient-need satisfaction,  in accordance with the  principle of an overall solution to the long-waited-for-facility.

 

The novelties concerning the financing of the Health Service as stated in the D. L. 502/1992 and following amendments , whereby “the adoption of quality assessment and auditing of  health activities and care given” has  increased both the expectation of patients and Health Organizations purchasers for better care quality and the need of Doctors and Health Organizations providers to possess assessment quality instruments .

 

The complexity of the nephrologist care sectors enhances the role of the professional care giver who has to guarantee  specialty and continuous integrated assistance in order to ensure the best results  for the patient he has been entrusted with. This task does not only mean a  professional scientific preparation in the case of the Nephrologist, but also for the Dialysis Unit Technicians and Nurses, so as to achieve high quality structural and functional standards and possibly  patient accessibility and encouragement.

 

In this attempt, Nephrologists have organized professional specialized courses for  Nurses working in Dialysis units. Moreover, the former have actively taken part in drawing up regional plans for health care interventions in favour of patients with renal diseases (in particular of uremics) as well as in setting up the Dialysis and Transplant Registers as means of  checking , storing  and comparing data .

 

The Italian Society of Nephrology has brought out guidelines on Nephrology and Dialysis to contribute to the realization of the project “defence for patients with renal diseases ”  bearing in mind   the three year National Health Care Plan.

 

Participation in various activities and programs on quality care assurance gave support to groups and patient Associations and constituted a continuous commitments too during the last years.

 

All the fore-mentioned efforts regarding continuous improvement in the quality of care, that have centred the patient and his needs at the centre of their attention, have contributed to the setting up an excellence Accreditation model, that has been adopted by the Italian Society of Nephrology as a model of improvement since 1997. The challenge was to raise  the overall  level of the  Health services, a way of coping with  topics of discussion, and keeping  research and  teaching as active as possible with the aim to create innovative solutions.

 

Improvement in the quality of the  National Health system, surely,  requires active participation under the guide of those who strive to this aim. Thus, the involvement of Doctors and Health care providers may not simply  be an  auspice, but  rather  an essential  element  of the project.

 

The new “Health market” is likely to provide new incentives as to the  efficiency of care, but might conceal dangerous implications unless appropriate technical quality control is applied. This check-up should  be made on the basis of providing the most suitable care and on assessing  health status and quality of life. With this aim therefore, clinical pathways and guidelines have been set up in compliance with   the knowledge emerging from  scientific evidence.

 

Monitoring of care has been stressed both as regards the evaluation of performance and auditing of structural organization. A means which may allow continuous assessment of the structural and organizational parameters in excellence Accreditation may be developed by those  typically processing dimensions such as accessibility, timely reply, continuity, integration. This model might permit  us to reduce “the grey area” in which Medicine moves , and might give an answer to the  growing need for  informed participation in  Health choices, as a guide among  the options  connected with the continuous technological evolution and the increasing economical costs of  the Health system.

 

The logic we refer to is of a comparative type, typical of  “benchmark systems” that do not persecute the fulfilment of predetermined standards in accordance with conformity, but  rather, use as a  surveying element, reference indexes which continually vary in  time and  space. Since indexes are bound to obtaining the best results  in a particular context (service, operative unit, division), starting from the hypothesis that the best clinical practice may be linked to this context, they might continually change in relation to the improvement and evolution of scientific knowledge.

 

 

The first result is the singling out of “Minimal structural requirements” and  “Minimal outputs” that might guarantee acceptable performance quality (Giornale Italiano  di Nefrologia 1996; 13:427-437). For different care sectors and expected level of intervention, appropriate functional relationships as well as general requirements, environmental equipments,  technological and organizational characteristics have been underlined.

 

A preliminary assessment of quality dialysis indicators was the  second result, obtained with  the “Delfi” method by means of a repetitive consultation among experts (Giornale Italiano  di Nefrologia 1998; 15 321-329).

 

This activity is now operating under the supervision of the “Quality & Accreditation” Committee of  Italian Society of Nephrology.

 

 

Alberto Giangrande and Giorgio Triolo, July 2001.