End Stage Renal Disease (ESRD): Plan of Care for Inadequate Peritoneal Dialysis (NQF 0321)

eMeasure Name End Stage Renal Disease (ESRD): Plan of Care for Inadequate Peritoneal Dialysis eMeasure Id 896EB5FF-5C5B-4CCC-85D0-DE1DAC4B1BDD
Version number 1 eMeasure Set Id 1499184D-46C1-4A12-B458-E1CF2CDBC262
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 patients aged 18 years and older with a diagnosis of ESRD receiving peritoneal dialysis who have a Kt/V>=1.7 OR patients wo havea Kt/V<1.7 with a documented plan of care 3 times a year (every 4 months) during the 12 month reporting period.
Copyright
© 2010 American Medical Association. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Patients receiving peritoneal dialysis must be monitored (by assessing Kt/V) regularly to ensure that their dialysis dose is sufficient. A patient receiving peritoneal dialysis whose Kt/V level is less than 1.7 is not receiving optimal dialysis. This measure assesses whether the treating physician addressed the low Kt/V level. A plan of care (may include assessing for non-adherence with the peritoneal prescription, sampling, and collection; assessing for error in the peritoneal dialysis prescription and/or inadequate monitoring of the delivered dose; performing peritoneal equilibrium testing; assessing for inadequate patient education; increasing the exchange volume; or increasing the number of exchanges per 24 hours) should be documented by the physician for every time Kt/V is less than 1.7.
Clinical Recommendation Statement
Total solute clearance (residual kidney and peritoneal, in terms of Kt/Vurea) should be measured within the first month after initiating dialysis therapy and at least once every 4 months thereafter. (KDOQI™)

For patients with residual kidney function (considered to be significant when urine volume is > 100 mL/d): The minimal "delivered" dose of total small-solute clearance should be a total (peritoneal and kidney) Kt/Vurea of at least 1.7 per week.

For patients without RKF (considered insignificant when urine volume is <=100 mL/d): The minimal "delivered" dose of total small-solute clearance should be a peritoneal Kt/Vurea of at least 1.7 per week measured within the first month after starting dialysis therapy and at least once every 4 months thereafter. (KDOQI™)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy, Update 2006. Available at: http://www.kidney.org/professionals/KDOQI/guidelines.cfm.
Definition
Plan of Care: A documented plan of care may include assessing for non-adherence with the peritoneal prescription, sampling, and collection; assessing for error in the peritoneal dialysis prescription and/or inadequate monitoring of the delivered dose; performing peritoneal equilibrium testing; assessing for inadequate patient education; increasing the exchange volume; increasing the number of exchanges per 24 hours; assessing for modality (CAPD or CCPD).
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 peritoneal dialysis during the measurement period.
Definition
Denominator(s): All patients aged 18 years and older with a diagnosis of ESRD receiving peritoneal dialysis.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who have a Kt/V>=1.7 OR patients who have a Kt/V<1.7 with a documented plan of care 3 times a year (every 4 months) during the 12 month reporting period.
Definition
Denominator Exception(s): N/A
Guidance
The numerator logic requires that a Kt/V value is performed at least once in every consecutive 4 month period (beginning with January 1) with an allowance for a 7-day overlap.  Therefore, the 4 month periods are: December 23 (of the prior year) to May 7 (of the current year); April 23 to September 7 (of the current year), August (need date) (of the current year) to January 7 ( of the subsequent year).
		
Note, in each four month period a Kt/V value is expected (and intervention (plan of care) if the value is too low).  However, if peritoneal dialysis was not performed during that four month period, the patient remains in the measure. Hence the numerator includes (a) Kt/V value => 1.7 OR Kt/V < 1.7 AND intervention is performed, OR No peritoneal dialysis occurred during that four month period.

To account for leap years, for the first four-month period, the timing window is 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 four-month periods, 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").
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