Mallika L Mendu1, Sri Lekha Tummalapalli2, Krista L Lentine3, Kevin F Erickson4, Susie Q Lew5, Frank Liu6,7, Edward Gould8, Michael Somers9, Pranav S Garimella10, Terrence O'Neil11, David L White12, Rachel Meyer12, Scott D Bieber13, Daniel E Weiner14. 1. Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; mmendu@bwh.harvard.edu. 2. Division of Nephrology, University of California, San Francisco, San Francisco, California. 3. Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri. 4. Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas. 5. Division of Renal Diseases and Hypertension, George Washington University, Washington, DC. 6. The Rogosin Institute, New York, New York. 7. Weill Cornell Medical College, New York, New York. 8. Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee. 9. Division of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. 10. Division of Nephrology-Hypertension, University of California, San Diego, San Diego, California. 11. Nephrology Service and Dialysis Unit, Mountain Home Veteran Affairs Medical Center, Mountain Home, Tennessee. 12. American Society of Nephrology, Washington, DC. 13. Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington; and. 14. Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
Abstract
BACKGROUND: Leveraging quality metrics can be a powerful approach to identify substantial performance gaps in kidney disease care that affect patient outcomes. However, metrics must be meaningful, evidence-based, attributable, and feasible to improve care delivery. As members of the American Society of Nephrology Quality Committee, we evaluated existing kidney quality metrics and provide a framework for quality measurement to guide clinicians and policy makers. METHODS: We compiled a comprehensive list of national kidney quality metrics from multiple established kidney and quality organizations. To assess the measures' validity, we conducted two rounds of structured metric evaluation, on the basis of the American College of Physicians criteria: importance, appropriate care, clinical evidence base, clarity of measure specifications, and feasibility and applicability. RESULTS: We included 60 quality metrics, including seven for CKD prevention, two for slowing CKD progression, two for CKD management, one for advanced CKD and kidney replacement planning, 28 for dialysis management, 18 for broad measures, and two patient-reported outcome measures. We determined that on the basis of defined criteria, 29 (49%) of the metrics have high validity, 23 (38%) have medium validity, and eight (13%) have low validity. CONCLUSIONS: We rated less than half of kidney disease quality metrics as highly valid; the others fell short because of unclear attribution, inadequate definitions and risk adjustment, or discordance with recent evidence. Nearly half of the metrics were related to dialysis management, compared with only one metric related to kidney replacement planning and two related to patient-reported outcomes. We advocate refining existing measures and developing new metrics that better reflect the spectrum of kidney care delivery.
BACKGROUND: Leveraging quality metrics can be a powerful approach to identify substantial performance gaps in kidney disease care that affect patient outcomes. However, metrics must be meaningful, evidence-based, attributable, and feasible to improve care delivery. As members of the American Society of Nephrology Quality Committee, we evaluated existing kidney quality metrics and provide a framework for quality measurement to guide clinicians and policy makers. METHODS: We compiled a comprehensive list of national kidney quality metrics from multiple established kidney and quality organizations. To assess the measures' validity, we conducted two rounds of structured metric evaluation, on the basis of the American College of Physicians criteria: importance, appropriate care, clinical evidence base, clarity of measure specifications, and feasibility and applicability. RESULTS: We included 60 quality metrics, including seven for CKD prevention, two for slowing CKD progression, two for CKD management, one for advanced CKD and kidney replacement planning, 28 for dialysis management, 18 for broad measures, and two patient-reported outcome measures. We determined that on the basis of defined criteria, 29 (49%) of the metrics have high validity, 23 (38%) have medium validity, and eight (13%) have low validity. CONCLUSIONS: We rated less than half of kidney disease quality metrics as highly valid; the others fell short because of unclear attribution, inadequate definitions and risk adjustment, or discordance with recent evidence. Nearly half of the metrics were related to dialysis management, compared with only one metric related to kidney replacement planning and two related to patient-reported outcomes. We advocate refining existing measures and developing new metrics that better reflect the spectrum of kidney care delivery.
Authors: Jesse D Schold; Laura D Buccini; Michael P Phelan; Colleen L Jay; David A Goldfarb; Emilio D Poggio; John R Sedor Journal: Clin J Am Soc Nephrol Date: 2017-05-17 Impact factor: 8.237
Authors: Stephen Z Fadem; David R Walker; Greg Abbott; Amy L Friedman; Richard Goldman; Sue Sexton; Kim Buettner; Kris Robinson; Thomas G Peters Journal: Clin J Am Soc Nephrol Date: 2011-02-17 Impact factor: 8.237
Authors: Barry G Saver; Stephen A Martin; Ronald N Adler; Lucy M Candib; Konstantinos E Deligiannidis; Jeremy Golding; Daniel J Mullin; Michele Roberts; Stefan Topolski Journal: PLoS Med Date: 2015-11-17 Impact factor: 11.069