End Stage Renal Disease (ESRD): Plan of Care of Inadequate Hemodialysis in ESRD Patients (NQF 0323)

eMeasure Name End Stage Renal Disease (ESRD): Plan of Care of Inadequate Hemodialysis in ESRD Patients eMeasure Id 6D92B02E-7560-474D-B03F-DE3571D09FD9
Version number 1 eMeasure Set Id 23ACEC1B-3E8D-4D1C-8EE5-E86972C2FD11
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of patient calendar months during the 12 month reporting period in which patients aged 18 years and older with a diagnosis of ESRD and receiving hemodialysis have a Kt/V>=1.2 OR have a Kt/V<1.2 with a documented plan of care.
Copyright
© 2010 American Medical Association. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Patients receiving hemodialysis must be monitored (by assessing Kt/V) regularly to ensure that their dialysis dose is sufficient. A patient receiving hemodialysis whose Kt/V level is less than 1.2 is not receiving optimal dialysis. This measure assesses whether the treating physician addressed the low Kt/V level. A plan of care (action defined as checking for adequacy of the AV access, increasing the blood flow, increasing the dialyzer size, or increasing the time of dialysis sessions) should be documented by the physician for every time Kt/V is less than 1.2.
Clinical Recommendation Statement
Quantifying HD is the first step toward assessment of its adequacy. Fortunately, the intermittent rapid decrease in urea concentration during HD allows a relatively easy measurement of the dose. The delivered dose of HD should be measured at regular intervals no less than monthly. (KDOQI™)
The minimally adequate dose of HD given 3 times per week to patients with Kr less than 2 mL/min/1.73 m2 should be an spKt/V (excluding RKF) of 1.2 per dialysis. For treatment times less than 5 hours, an alternative minimum dose is a URR of 65%. The target dose for HD given 3 times per week with Kr less than 2 mL/min/1.73 m2 should be an spKt/V of 1.4 per dialysis not including RKF, or URR of 70%. (KDOQI™)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Hemodialysis Adequacy, Update 2006. Available at: http://www.kidney.org/professionals/KDOQI/guidelines.cfm.
Definition
Plan of Care: A documented plan of care may include checking for adequacy of the AV access, increasing the blood flow, increasing the dialyzer size, increasing the time of dialysis sessions, adjusting dialysis prescription, or documenting residual renal function.
Definition
Initial Patient Population(s): Patient Age: Patients aged 18 years and older before the start of the measurement period.  Diagnosis, Active: Patient has a documented diagnosis of ESRD. Procedure: Patient receiving hemodialysis during the measurement period.
Definition
Denominator(s): Patient calendar months for patients aged 18 years and older with a diagnosis of ESRD who are receiving hemodialysis.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Number of patient calendar months during which patients have a Kt/V* ≥1.2 OR have Kt/V <1.2 with a documented plan of care for inadequate hemodialysis during the measurement period.  *Kt/V quantifies dialyzer clearance of urea (K), t indicates time; v indicates volume of distribution of urea.
Definition
Denominator Exclusion(s): N/A
Guidance
The numerator logic requires that a Kt/V value is performed at least once a calendar month during the measurement period with an allowance for a 3-day overlap at the beginning and end of the each month. 

Note, in each calendar month a Kt/V value is expected (and an intervention (plan of care) if the value is too low).  However, if hemodialysis was not performed during a given calendar month, the patient remains in the measure. Hence the numerator includes (a) Kt/V value => 1.2 OR Kt/V < 1.2 AND intervention is performed, OR No hemodialysis occurred during that calendar month.

To account for leap years, for the first three months of the measurement period, the timing windows are defined as days forward from the start of the measurement period (i.e. x days starts after the start of the "Measurement period"); for the remainder of the measurement period, the timing windows are defined as days backward from the measurement end date (i.e. x days starts before or during the "Measurement end date").

Dialysis can occur during inpatient admissions as well as in the home or ambulatory dialysis unit (among other settings). The measure is a physician measure of management for dialysis procedures. As such the information about which patients the physician is treating should be in the physicians practice management system or EHR. Some data may not be directly available to the physician without an HIE or interoperability directly with other settings. Refer to measure developer if the measure can be performed only on the procedures that occur in a single setting.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012