Improving the Quality of In-Center Hemodialysis Care

From the inception of this project, CMS and AHRQ intended for the In-Center Hemodialysis Survey to serve facilities and networks as a tool for quality improvement.  To that end, the CAHPS grantees organized an initiative to assess the survey’s value in helping facilities and Networks to identify and remedy problem areas. This project began in the spring of 2005 and ended in September 2006. 


Seven of the 32 dialysis facilities that field tested the survey expressed interest in collaborating with the CAHPS grantees on this project. Each of these seven facilities was associated with one of the following four Networks:

  • ESRD Network of New England
  • The ESRD Network of Texas
  • The Mid-Atlantic Renal Coalition
  • Intermountain End-Stage Renal Disease Network [the coordinating network]

Initial Activities

Measuring and reporting. Working closely with their Networks, these facilities administered the CAHPS In-Center Hemodialysis Survey to their patients in the second quarter of 2005. Based on consultations with facility and Network staff, the American Institutes for Research (AIR) designed, tested, and developed a special report to present the information on the results of the CAHPS survey to facility staff involved in quality improvement activities. For a sample of this report, contact the CAHPS User Network at or 1-800-492-9261.

Identifying opportunities to improve. Grantees then assembled support teams to work with Networks and corresponding facilities during this process. In July, the facilities reviewed their results and began the process of identifying opportunities for improvement. Target areas included issues like communication between staff and patients, and patients’ perceptions of staff availability and professionalism.

Assessing potential interventions. In August of 2005, CMS and AHRQ sponsored a kick-off meeting with representatives from all participating dialysis facilities, Networks, and grantee organizations to discuss these opportunities and potential interventions. The facilities proposed quality improvement projects based on their survey results, while speakers presented information on involving patients and families in quality improvement and applying the Rapid Cycle Improvement method. This technique emphasizes testing small-scale changes based on defined aims and then refining these changes in preparation for broader implementation. 

Implementing Strategies to Improve Quality

During the fall and winter of 2005, the Networks, facilities, and CAHPS grantees worked together to implement quality improvement strategies and activities. For instance, some facilities developed more effective means of educating patients about important issues such as treatment options for end-stage renal disease. Others have established Patient Advisory Councils to get more direct feedback from patients on an ongoing basis.

Progress Reported to CMS

In the summer of 2006, the grantees conducted a second set of site visits to several of the participating facilities to discuss their experiences. Participating facilities also resurveyed their patients to assess the effectiveness of their quality improvement efforts.

Based on the information gathered from the site visits and other sources, the grantees produced a formal report to CMS on the successes, challenges, and lessons learned from this ambitious project to improve the experiences of hemodialysis patients based on CAHPS survey data.

Page last reviewed March 2016
Page originally created June 2013
Internet Citation: Improving the Quality of In-Center Hemodialysis Care. Content last reviewed March 2016. Agency for Healthcare Research and Quality, Rockville, MD.
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