Effectiveness of Care: Maternal and Child Health 2009 National Healthcare Quality and Disparities ReportsThe 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. Effectiveness of Care: End Stage Renal DiseaseManagement 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 fistulaManagement of End Stage Renal DiseaseMeasure TitleAdult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater).Measure SourceUniversity of Michigan Kidney Epidemiology and Cost Center (UMKECC), Dialysis Facility Reports.National Tables3_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 SourceCenters for Medicare & Medicaid Services (CMS), ESRD Clinical Performance Measures Project (ESRD-CPMP).National DenominatorMedicare hemodialysis patients age 18 and over.National NumeratorSubset of the denominator population with urea reduction ratio (URR) 65 percent or greater.State Tables3_1_1.3 Adult hemodialysis patients with adequate dialysis (urea reduction ratio 65% or greater), by State, 2000 and 2007.State Data SourceUMKECC, Unit Specific Report (USR).State DenominatorMedicare hemodialysis patients.State NumeratorSubset of the denominator population with urea reduction ratio (URR) 65 percent or greater.CommentsStandard error was calculated based on sample N, not sampling unit; therefore, reported standard error may be understated.Top of PageManagement of End Stage Renal DiseaseMeasure TitleDialysis patients under age 70 who were registered on a waiting list for transplantation.Measure SourceHealthy People 2010.National Tables3_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 SourceNational Institutes for Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).National DenominatorAll 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 NumeratorSubset 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 Tables3_1_2.3 Dialysis patients under age 70 who were registered on a waiting list for transplantation, by State, 1999 and 2005.State Data SourceNIH, NIDDK, USRDS.State DenominatorSame as National.State NumeratorSame as National.CommentsThe 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 documentationTop of PageManagement of End Stage Renal DiseaseMeasure TitlePatients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure.Measure SourceHealthy People 2010.National Tables3_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 SourceNational Institutes for Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).National DenominatorAll 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 NumeratorSubset of the denominator population receiving a transplant within 3 years of renal failure.State Tables3_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 SourceNIH, NIDDK, USRDS.State DenominatorSame as National.State NumeratorSame as National.CommentsThe 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.Top of PageManagement of End Stage Renal DiseaseMeasure TitleRatio of observed deaths to expected deaths among Medicare hemodialysis patients.Measure SourceUniversity of Michigan Kidney Epidemiology and Cost Center (UMKECC), Unit Specific Report.State Tables3_1_4.1 Ratio of observed deaths to expected deaths among Medicare hemodialysis patients, by State, 2000 and 2007.State Data SourceUMKECC, Unit Specific Report (USR).State DenominatorMedicare dialysis patients.State NumeratorStandardized mortality among the denominator population.CommentsStandardized 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.Top of PageManagement of End Stage Renal DiseaseMeasure TitleAdult hemodialysis patients whose primary mode of vascular access is an arteriovenous fistula.Measure SourceCenters for Medicare & Medicaid Services (CMS), End Stage Renal Disease Clinical Performance Measures Project.Tables3_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 SourceCMS, 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.NumeratorFor (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. AHRQ Home | Questions? | Contact AHRQ | Site Map | Accessibility | Privacy Policy | Freedom of Information Act | Disclaimers | Plain Writing Act U.S. Department of Health & Human Services | The White House | USA.gov: The U.S. Government's Official Web PortalAgency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 Telephone: (301) 427-1364 Current as of March 2010 Internet Citation: Effectiveness of Care: Maternal and Child Health: 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