A continuous quality improvement paradigm for health care networks

  • Edmund G. Lowrie
Part of the Developments in Nephrology book series (DINE, volume 39)


Continuous Quality Improvement (CQI) is a matter of philosophy, not technique; hence, I offer those quotations. The paradigm is born of attitude more than discipline, particularly in distributed service networks like health care organizations. It applies practical, goal directed, clinical science to hierarchical human productivity systems. The goal is clear; define quality in some simple term(s) and pursue it with dispatch and vigor. Scientific inquiry is the method meaning that preconception, bias, and tradition for the sake of itself can play no role. Improvement is always possible, particularly in fields such as medicine where the knowledge base changes rapidly, so the inquiry is ongoing.


Control Chart Support Organization Continuous Quality Improvement Death Risk Serum Albumin Concentration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Peirce CS. The fixation of belief. In Butler J, editor. Philosophical writings of Peirce., New York, Dover Publications, 1955.Google Scholar
  2. 2.
    McDermott JJ. The writings of William James. Chicago, University of Chicago Press, 1977.Google Scholar
  3. 3.
    Deming WE. Out of the crisis. Cambridge, MA, MIT Centers for Advanced Engineering, 1986.Google Scholar
  4. 4.
    Shewhart WA. Economic control of quality of manufactured product. Van Strand, 1931. RPR Ed; American Society of Quality Control, 1980.Google Scholar
  5. 5.
    Deming WE. The new economics for industry, government, education, 2nd edition. Cambridge, MA, MIT Centers for Advanced Engineering, 1994.Google Scholar
  6. 6.
    Walton M. The Deming management method. New York, Putnam Publishing Group, 1986.Google Scholar
  7. 7.
    Lowrie EG. The United States renal data system, a public treasure — how best to use it? Semin Dialysis (In press).Google Scholar
  8. 8.
    Lowrie EG, Huang W, Lew NL, and Liu Y. Analysis of 1991 mortality data. Memorandum to DSD Medical Directors, February 26, 1993.Google Scholar
  9. 9.
    Lowrie EG, Huang WH, Lew NL and Liu Y. The relative contribution of measured variables to death risk among hemodialysis patients. In Friedman E, editor. Death on hemodialysis: preventable or inevitable? Hingham, Kluwer Academic Publishers, 1994; 121–4.Google Scholar
  10. 10.
    Lowrie EG. Chronic dialysis treatment: clinical outcome and related processes of care. Am J Kid Dis 1994; 24:255–66.PubMedGoogle Scholar
  11. 11.
    Lowrie EG. The measurement of urea reduction ratio (URR) and Kt/V: a laboratory enhancement for monitoring dialysis exposure. Memorandum to DSD Medical Directors, May 11, 1990.Google Scholar
  12. 12.
    Lowrie EG and Lew NL. Urea reduction ratios (URR): data to assist the interpretation of statistics for your dialysis unit. Memorandum to DSD Medical Directors, November 9, 1990.Google Scholar
  13. 13.
    Lowrie EG, Lew NL and Liu Y. The effect of differences in urea reduction ratio (URR) on death risk in hemodialysis patients: a preliminary analysis. Memorandum to DSD Medical Directors, November 5, 1991.Google Scholar
  14. 14.
    Lowrie EG and Lew NL. The urea reduction ratio (URR): A simple method for evaluating hemodialysis treatment. ContempDial Nephrol 1991; 11–20.Google Scholar
  15. 15.
    Owen WF Jr, Lew NL, Liu Y, Lowrie EG and Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. New Engl J Med 1993; 329:1001–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Lowrie EG, Zhu X, Zhang H, Lew NL and Lazarus JM. Death risk profiles associated with the urea reduction ratio (URR) in review: 1991 through 1994. Memorandum to DSD Medical Directors, September 27, 1996.Google Scholar
  17. 17.
    Lowrie EG and Ma L. Time trends for EPO dose: Hematocrit, serum iron and other matters. Memorandum to DSD Medical Directors, May 30, 1995.Google Scholar
  18. 18.
    Lowrie EG, Ling L and Lew NL. The anemia of ESRD and related thoughts about iron and EPO therapy. Memorandum to DSD Medical Directors, August 10, 1995.Google Scholar
  19. 19.
    Madore F, Lowrie EG, Brugnara C, Lew NL, Lazarus JM, Bridges K and Owen WF: Anemia in hemodialysis patients: Variables affecting this outcome predictor. J Am Soc Nephrol 1997; 8:1921–9.PubMedGoogle Scholar
  20. 20.
    Lowrie EG, Ma L, Zhang J and Lew NL. Thoughts about anemia, iron, proteins, and a ‘chronic acute phase’ state among hemodialysis patients. Memorandum to DSD Medical Directors, February 14, 1996.Google Scholar
  21. 21.
    Lowrie EG, Zhang J and Lew NL. Acute phase process among patients with kidney failure: extended observations and related thoughts. Memorandum to DSD Medical Directors, March 19, 1996.Google Scholar
  22. 22.
    Lowrie EG. Conceptual model for a core pathobiology of uremia with special reference to anemia, malnourishment, and mortality among dialysis patients. Semin Dialysis 1997; 10:115–29.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Edmund G. Lowrie

There are no affiliations available

Personalised recommendations