Measuring Quality in Kidney Care: An Evaluation of Existing Quality Metrics and Approach to Facilitating Improvements in Care Delivery
Measuring Quality in Kidney Care: An Evaluation of Existing Quality Metrics and Approach to Facilitating Improvements in Care Delivery
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DOI：
10.1681/asn.2019090869
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发表时间：
2020-03-01
影响因子：
13.6
通讯作者：
Weiner, Daniel E.
中科院分区：
文献类型：
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作者：
Mendu, Mallika L.;Tummalapalli, Sri Lekha;Weiner, Daniel E.
利用质量指标可以是一种有效的方法，用于识别影响患者结局的肾脏疾病护理中的实质性绩效差距。然而，衡量标准必须是有意义的，循证的，可归因的，可行的，以改善医疗服务。作为美国肾脏病学会质量委员会的成员，我们评估了现有的肾脏质量指标，并提供了一个框架的质量测量，以指导临床医生和决策者。方法我们编制了一份全面的名单，国家肾脏质量指标从多个既定的肾脏和质量组织。为了评估这些指标的有效性，我们根据美国医师学会的标准进行了两轮结构化指标评估：结果我们纳入了60个质量指标，包括7个用于CKD预防，2个用于减缓CKD进展，2个用于CKD管理，1例用于晚期CKD和肾脏替代计划，28例用于透析管理，18例用于广义指标，2例患者报告结局指标。我们确定，在定义的标准的基础上，29（49%）的指标具有高效度，23（38%）具有中等效度，和8（13%）具有低validity.Conclusions，我们评为不到一半的肾脏疾病质量指标高度有效的;其他下跌短，因为不明确的归属，不充分的定义和风险调整，或与最近的证据不一致。近一半的指标与透析管理有关，而只有一个指标与肾脏替代计划有关，两个指标与患者报告的结局有关。我们主张完善现有的措施，并开发新的指标，以更好地反映肾脏护理服务的范围。
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, evidencebased, 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.