Performance Measurement in Chronic Kidney Disease

Smith, Kimberly A.; Hayward, Rodney A.

doi:10.1681/asn.2010111152

Cited by 27 publications

(25 citation statements)

References 100 publications

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“…Likewise, how best to define CKD specific performance measures and ultimately value in providing care to patients with CKD has not been established. 36 …”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Jolly¹,

Navaneethan

Schold

et al. 2014

Am J Nephrol

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Background: Whether chronic kidney disease (CKD) recognition in an electronic health record (EHR) problem list improves processes of care or clinical outcomes of end-stage renal disease (ESRD) and death is unclear. Methods: We identified patients who had at least 1 year of follow-up (2005-2009) in our EHR-based CKD registry (n = 25,742). CKD recognition was defined by having ICD-9 codes for CKD, diabetic kidney disease, or hypertensive kidney disease in the problem list. We calculated proportions of patients with and without CKD recognition and examined differences by demographics, clinical factors, and development of ESRD or mortality. We evaluated differences in the proportion of patients with CKD-specific laboratory results checked before and after recognition among cases and propensity-matched controls. Results: Only 11% (n = 2,735) had CKD recognition in the problem list and they were younger (68 vs. 71 years), a higher proportion were male (61 vs. 37%) and African-American (21 vs. 10%) compared to those unrecognized. CKD-specific laboratory results for patients with estimated glomerular filtration rate (eGFR) 30-59 including intact parathyroid hormone (23 vs. 6%), vitamin D (22 vs. 18%), phosphorus (29 vs. 7%), and a urine check for proteinuria (55 vs. 36%) were significantly more likely to be done among those with CKD recognition (all p < 0.05). Similar results were found for eGFR <30 except for proteinuria and in our propensity score-matched control analysis. There was no independent association of CKD recognition with ESRD or mortality. Conclusions: CKD recognition in the EHR problem list was low, but translated into more CKD-specific processes of care; however ESRD or mortality were not affected.

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“…Likewise, how best to define CKD specific performance measures and ultimately value in providing care to patients with CKD has not been established. 36 …”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Jolly¹,

Navaneethan

Schold

et al. 2014

Am J Nephrol

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“…The latter are also more susceptible to case-mix variation, care processes outside the direct control of the QI team and to variation in how the case mix is coded. 10,[13][14][15][16] Practice variation can only be identified by collecting data on several providers or facilities and comparing the results. Therefore, measurement usually occurs at the regional or national level.…”

Section: Measuring Practice Variationmentioning

confidence: 99%

Learning from practice variation to improve the quality of care

Tomson

Veer

2013

Clinical Medicine

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-Modern medicine is complex and delivered by interdependent teams. Conscious redesign of the way in which these teams interact can contribute to improving the quality of care by reducing practice variation. This requires techniques that are different to those used for individual patient care. In this paper, we describe some of these quality improvement (QI) techniques. The first section deals with the identification of practice variation as the starting point of a systematic QI endeavour. This involves collecting data in multiple centres on a set of quality indicators as well as on case-mix variables that are thought to affect those indicators. Reporting the collected indicator data in longitudinal run charts supports teams in monitoring the effect of their QI effort. After identifying the opportunities for improvement, the second section discusses how to reduce practice variation. This includes selecting the `package' of clinical actions to implement, identifying subsidiary actions to achieve the improvement aim, designing the implementation strategy and ways to incentivise QI.

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“…CPGs offer clinicians specific evidence-based care algorithms, designed to result in better patient outcomes. CPMs are clearly defined measures, specifying definitions of numerator and denominator to assess how well a population of patients adheres to a specific CPG (4). Selected CPMs have been used by the Centers for Medicare and Medicaid Services (CMS) and commercial insurers as measures of quality.…”

Section: Introductionmentioning

confidence: 99%

Quality Measures for Dialysis

Kliger

2016

Clinical Journal of the American Society of Nephrology

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Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care.

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Performance Measurement in Chronic Kidney Disease

Cited by 27 publications

References 100 publications

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Chronic Kidney Disease in an Electronic Health Record Problem List: Quality of Care, ESRD, and Mortality

Learning from practice variation to improve the quality of care

Quality Measures for Dialysis

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