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Clin Exp Nephrol. 2017 Apr;21(2):247-256. doi: 10.1007/s10157-016-1274-8. Epub 2016 May 4.

Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method.

Author information

1
Department of Healthcare Epidemiology, Kyoto University, Yoshida-konoe, Sakyo-ku, Kyoto, Japan.
2
Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Hikarigaoka 1, Fukushima, Japan.
3
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan.
4
Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-kawaramachi 54, Sakyou-ku, Kyoto, Japan.
5
Hatta Medical Clinic, Shugakuin Yakushido 4, Sakyo-ku, Kyoto, Japan.
6
Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan.
7
Kidney Unit, National Fukuoka Higashi Medical Center, Chidori 1-1-1, Koga, Fukuoka, Japan.
8
Department of Nephrology and Rheumatology, Japan Labour Health and Welfare Organization Chubu Rosai Hospital, 1-10-5 Komei, Minato-ku, Nagoya, Japan.
9
Internal Medicine, Suzu General Hospital, 1-1 Nonoe-Yu, Suzu, Ishikawa, Japan.
10
Shichijo Clinic, 29 Sujaku-kitanokuchi-cho, Shimogyo-ku, Kyoto, Japan.
11
Japan Community Health Care Organization (JCHO), Tokyo Takanawa Hospital, Takanawa 3-10-11, Minato-ku, Tokyo, Japan.
12
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. shibagaki@marianna-u.ac.jp.

Abstract

BACKGROUND:

The prevalence of chronic kidney disease (CKD) has recently increased, and maintaining high quality of CKD care is a major factor in preventing end-stage renal disease. Here, we developed novel quality indicators for CKD care based on existing electronic health data.

METHODS:

We used a modified RAND appropriateness method to develop quality indicators for the care of non-dialysis CKD patients, by combining expert opinion and scientific evidence. A multidisciplinary expert panel comprising six nephrologists, two primary care physicians, one diabetes specialist, and one rheumatologist assessed the appropriateness of potential indicators extracted from evidence-based clinical guidelines, in accordance with predetermined criteria. We developed novel quality indicators through a four-step process: selection of potential indicators, first questionnaire round, face-to-face meeting, and second questionnaire round.

RESULTS:

Ten expert panel members evaluated 19 potential indicators in the first questionnaire round, of which 7 were modified, 12 deleted, and 4 newly added during subsequent face-to-face meetings, giving a final total of 11 indicators. Median rate of these 11 indicators in the final set was at least 7, and percentages of agreement exceeded 80 % for all but one indicator. All indicators in the final set can be measured using only existing electronic health data, without medical record review, and 9 of 11 are process indicators.

CONCLUSION:

We developed 11 quality indicators to assess quality of care for non-dialysis CKD patients. Strengths of the developed indicators are their applicability in a primary care setting, availability in daily practice, and emphasis on modifiable processes.

KEYWORDS:

Administrative claims data; Chronic kidney disease; Quality indicators; Quality of care; RAND

PMID:
27145768
DOI:
10.1007/s10157-016-1274-8
[Indexed for MEDLINE]

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