Effectiveness of Care: End Stage Renal Disease

2009 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.


Management of End Stage Renal Disease
Adult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater)
Dialysis patients under age 70 who were registered on a waiting list for transplantation
Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure
Ratio of observed deaths to expected deaths among Medicare hemodialysis patients
Adult hemodialysis patients whose primary mode of vascular access is an arteriovenous fistula
 


Management of End Stage Renal Disease

Measure Title

Adult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater).

Measure Source

University of Michigan Kidney Epidemiology and Cost Center (UMKECC), Dialysis Facility Reports.

National Tables

3_1_1.1 Adult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater), United States, 2002 and 2007.

3_1_1.2 Adult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater), United States, 2007, by:

  • Race.
  • Ethnicity.

National Data Source

Centers for Medicare & Medicaid Services (CMS), ESRD Clinical Performance Measures Project (ESRD-CPMP).

National Denominator

Medicare hemodialysis patients age 18 and over.

National Numerator

Subset of the denominator population with urea reduction ratio (URR) 65 percent or greater.

State Tables

3_1_1.3 Adult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater), by State, 2000 and 2007.

State Data Source

UMKECC, Unit Specific Report (USR).

State Denominator

Medicare hemodialysis patients.

State Numerator

Subset of the denominator population with urea reduction ratio (URR) 65 percent or greater.

Comments

Standard error was calculated based on sample N, not sampling unit; therefore, reported standard error may be understated.

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Management of End Stage Renal Disease

Measure Title

Dialysis patients under age 70 who were registered on a waiting list for transplantation.

Measure Source

Healthy People 2010.

National Tables

3_1_2.1 Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 1999 and 2005.

3_1_2.2 Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 2005, by:

  • Race.
  • Ethnicity.

National Data Source

National Institutes for Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).

National Denominator

All incident end stage renal disease (ESRD) Medicare patients in the given year who were under age 70 and had a known State of residence in the 50 States or DC. Patients who received a transplant at any time from a live donor were excluded from the measure.

National Numerator

Subset of the denominator population who were registered on the kidney transplant waiting list on December 31 of the measure year or received a deceased-donor kidney within 1 year of their ESRD initiation date.

State Tables

3_1_2.3 Dialysis patients under age 70 who were registered on a waiting list for transplantation, by State, 1999 and 2005.

State Data Source

NIH, NIDDK, USRDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The measure was calculated as the percentage (by Kaplan-Meier methodology) who were wait-listed or received a deceased-donor kidney within 1 year of their ESRD initiation date.

This measure is referred to as measure 4-5 in Healthy People 2010 documentation

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Management of End Stage Renal Disease

Measure Title

Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure.

Measure Source

Healthy People 2010.

National Tables

3_1_3.1 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, United States, 1992-1994 and 2003.

3_1_3.2 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, United States, 2003, by:

  • Race.
  • Ethnicity.

National Data Source

National Institutes for Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).

National Denominator

All Medicare dialysis patients who initiated therapy in the given year and had a known State of residence in the 50 States or DC, excluding patients with prior kidney transplants and patients over the age of 69.

National Numerator

Subset of the denominator population receiving a transplant within 3 years of renal failure.

State Tables

3_1_3.3 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, by State, 1992-1994 and 2003.

State Data Source

NIH, NIDDK, USRDS.

State Denominator

Same as National.

State Numerator

Same as National.

Comments

The Healthy People 2010 measure refers to “within 3 years of registration on a waiting list.” Measuring transplants within 3 years of renal failure yields a more complete picture of access to transplantation.

This measure is referred to as measure 4-6 in Healthy People 2010 documentation.

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Management of End Stage Renal Disease

Measure Title

Ratio of observed deaths to expected deaths among Medicare hemodialysis patients.

Measure Source

University of Michigan Kidney Epidemiology and Cost Center (UMKECC), Unit Specific Report.

State Tables

3_1_4.1 Ratio of observed deaths to expected deaths among Medicare hemodialysis patients, by State, 2000 and 2007.

State Data Source

UMKECC, Unit Specific Report (USR).

State Denominator

Medicare dialysis patients.

State Numerator

Standardized mortality among the denominator population.

Comments

Standardized mortality ratios (SMRs) are used to compare mortality in annual incident populations over successive years of observation. The death rates are high during the first year of treatment, decrease during the second and third years, and rise again after the fourth year.

The Dialysis Facility Compare measure “patient survival rate” is equivalent to the University of Michigan SMR.

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Management of End Stage Renal Disease

Measure Title

Adult hemodialysis patients whose primary mode of vascular access is an arteriovenous fistula.

Measure Source

Centers for Medicare & Medicaid Services (CMS), End Stage Renal Disease Clinical Performance Measures Project.

Tables

3_1_5.1 Adult hemodialysis patients who have an arteriovenous fistula as their primary mode of vascular access, United States, 2002 and 2007.

3_1_5.2 Adult hemodialysis patients who received an arteriovenous fistula as their primary mode of vascular access, United States, 2007, by:

  • Race.
  • Ethnicity.

Data Source

CMS, ESRD Clinical Performance Measures Project (ESRD-CPMP).

Denominator

(1) Medicare incident adult in-center hemodialysis patients, age 18 and over (defined as those patients initiating their most recent course of hemodialysis), or (2) prevalent adult (age 18 and over) hemodialysis patients in the sample for analysis.

Numerator

For (1): The number of incident patients in the denominator who were dialyzed using an arteriovenous fistula during their last hemodialysis treatment.
For (2): The number of prevalent patients in the denominator who were dialyzed using an arteriovenous fistula during their last hemodialysis treatment during the study period.

 

Current as of March 2010
Internet Citation: Effectiveness of Care: End Stage Renal Disease: 2009 National Healthcare Quality and Disparities Reports. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr09/measurespec/end_stage_renal_disease.html