Patient-Reported Outcome and Experience Measures as Quality Metrics of Health Care Quality in Patients Receiving Dialysis.

In dialysis, the inclusion of patient-reported outcomes is relatively new. However, the genesis of patient-reported outcomes as an essential component to measuring the quality of care began over 50 years ago. Although much progress has been made, there are still substantial efforts needed to reach true patient-centeredness in health care quality assessment. Patient-centeredness is an iterative, collaborative process of shared decision-making among stakeholders to identify, address, and resolve issues of importance to patients. This shift to putting patients at the forefront of decision-making requires consideration and implementation of ethical principles. Opportunities for patient participation in quality assessment are broad and representation is necessary to avoid exacerbating health inequities and to achieve varied viewpoints. Many resources exist for selecting instruments that assess patient-reported outcomes and barriers to implementation on all levels must be considered before selecting an instrument for quality assessment. Particular attention needs to be paid to the respondent burden from the patient's point of view. Thoughtful implementation of new initiatives that include patients as equal stakeholders could finally propel quality assessment in kidney disease to meet the vision proposed be Avedis Donabedian over 50 years ago.