Quality Measures
Clinical Performance Measures
In 1998, in response to the Balanced Budget Act of 1997, CMS developed ESRD Clinical Performance Measures (CPMs) based on the National Kidney Foundation's Kidney Disease Quality Initiative Clinical Practice Guidelines. Sixteen CPMs were developed to measure and report the quality of dialysis services provided under Medicare in the areas of adequacy of hemodialysis and peritoneal dialysis, anemia management, and vascular access management.
CPM data are collected on a national random sample of adult in-center hemodialysis patients, all in-center hemodialysis patients less than 18 years of age, and a national random sample of adult peritoneal dialysis patients. Thirteen of the CPMs are calculated, and an annual report of these findings is published and made available to the public. CPM data are not collected in numbers sufficient for calculating dialysis facility-specific rates. However, CMS is collaborating with the major large dialysis organizations to collect and transmit CPM data electronically on all their dialysis patients.
The ESRD CPMs include the following:
- Delivered hemodialysis dose is measured monthly
- Method used to calculate the delivered hemodialysis dose
- Adequacy of the delivered hemodialysis treatment
- Peritoneal dialysis total solute clearance is measured regularly
- Peritoneal dialysis dose and total solute clearances are measured in a standard way
- Adequacy of the delivered peritoneal dialysis dose
- Number of hemodialysis patients with an arterial venous fistula
- Number of hemodialysis patients with a catheter
- Monitoring arterial venous grafts for stenosis
- Target hemoglobin for patients on Epoetin therapy
- Assessment of iron stores
- Maintenance of iron stores
- Administration of supplemental iron
Measures Publicly Reported
Also in response to the Balanced Budget Act of 1997, CMS contracted with PRO-West (now known as Qualis Health), to recommend dialysis facility-specific measures that could be provided to the public for consumer choice and information purposes. A Consumer Workgroup, with input from a larger group of ESRD stakeholders, helped the contractor identify three quality measures for public reporting based on their importance in conveying how well patients are receiving quality care in a dialysis facility:
- The percent of Medicare hemodialysis patients treated in the facility that received adequate dialysis treatments.
- The percent of Medicare patients treated in the facility whose anemia was adequately managed.
- Patient survival categories are reported as expected, better than expected, and worse than expected.
Medicare administrative data are the source for the three dialysis facility-specific quality measures reported on DFC. These three measures are updated annually on DFC, using one year of data for the adequacy and anemia measure and four years of data for the patient survival measure.
Measures Under Development
CMS is funding the development of various measures. Currently the following measures are under development: Quality Measures for Kidney Transplant Referral, Quality Measures for ESRD Bone Disease and Metabolism, Vascular Access Measures for Public Reporting and Vascular Access Measures for Quality Improvement Organizations.
For more information, please visit http://www.cms.hhs.gov/ESRDQualityImproveInit/03_Quality%20Measures.asp.
Printed on Friday 12th of March 2010 06:05:41 AM
http://esrd.ipro.org/index/fistula-quality-measures