The prevalence of patients with End Stage Renal Disease (ESRD) has increased and efforts to control cost and meet managed care demands for lower reimbursements, have resulted in the increased use of unlicensed personnel in dialysis treatment centers. There is considerable evidence that the need to reduce costs is having adverse effects on ESRD patient outcomes; tendencies toward unlicensed personnel usage and decreased treatment duration have resulted in increased mortality. Although these effects are reported, studies have failed to examine the effects on patient outcomes with regard to the competence and confidence levels of licensed and unlicensed providers of dialysis treatment to ESRD patients. Moreover, few if any investigators have attempted to empirically establish that there are true differences in skill between the two groups. This study will examine those issues.
Chronic Renal Failure is a progressive, irreversible loss of renal function that occurs over varying periods of time ranging from a few months to decades (Parker, 1998). At the end of 1997 there were 304,083 patients being treated for ESRD. During that year, 79,102 new patients started ESRD treatment. At the end of 1997, over 307,00 patients were receiving treatment for ESRD (point prevalence) while over 360,000 patients received ESRD treatment some time during 1997 (period prevalence includes ESRD patients who died in 1997) (Parker). In order to meet the demand for lower costs while treating higher numbers of persons with ESRD, many unlicensed personnel are being utilized in dialysis treatment centers.
Deteriorating quality of care may be the most serious outcome of this practice. Given rising costs and shrinking reimbursement, more and more hospitals are downsizing in an effort to shrink personnel costs. For the same reasons other health care administrators have restructured health care delivery systems by altering the staffing mix and replacing...