Effectiveness: End Stage Renal Disease 2010 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 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 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula Management of End Stage Renal Disease Measure TitleAdult hemodialysis patients with adequate dialysis.Measure SourceUniversity of Michigan Kidney Epidemiology and Cost Center (UMKECC), Dialysis Facility Reports.National Table3_1_1.1 Adult hemodialysis patients with adequate dialysis, United States, 2006-2009National Data SourceUMKECC, Unit Specific Report (USR).National DenominatorMedicare hemodialysis patients.National NumeratorSubset of the denominator population with a urea reduction ratio (URR) of 65% or higher.State Table3_1_1.2 Adult hemodialysis patients with adequate dialysis, by State, 2000-2008State Data SourceUMKECC, Unit Specific Report (USR).State DenominatorMedicare hemodialysis patients.State NumeratorSubset of the denominator with a URR of 65% or higher.CommentsStandard errors were calculated based on sample N, not sampling unit; therefore, reported standard errors may be understated.Top of Page Management 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, 1999-20063_1_2.2a-b Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 2006, 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 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 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 Table3_1_2.3 Dialysis patients under age 70 who were registered on a waiting list for transplantation, by State, 1999-2006State 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 either 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.Top of Page Management 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, 1998-20043_1_3.2a-b Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, United States, 2004, 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 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 receiving a transplant within 3 years of renal failure.State Table3_1_3.3 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, by State, 2000-2004State Data SourceNIH, NIDDK, USRDS.State DenominatorSame as National.State NumeratorSame as National.CommentsNote that 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.Top of Page Management 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 (USR).State Table3_1_4.1 Standardized mortality ratio for dialysis patients, by State, 2000-2008State Data SourceUMKECC, 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, are lower during the second and third years, and rise again after the fourth year.Note that the Compare measure pertinent to Dialysis Facility, "patient survival rate," is equivalent to the University of Michigan SMR.Top of Page Management of End Stage Renal DiseaseMeasure TitleNew end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula.Measure SourceCenters for Medicare & Medicaid Services (CMS).National Tables3_1_5.1 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, United States, 2008-2009, National Data Source CMS.National DenominatorAll incident hemodialysis patients in identified group in designated year.National NumeratorAll patients in the denominator for whom access used on first outpatient dialysis was given as "AVF."State Tables3_1_5.2 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, by State, 2008-2009State Data SourceCenters for Medicare & Medicaid Services (CMS).State DenominatorSame as National.State NumeratorSame as National.Top of Page Return to Measure Specifications 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 February 2011 Internet Citation: Effectiveness: End Stage Renal Disease: 2010 National Healthcare Quality and Disparities Reports. February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr10/measurespec/end_stage_renal_disease.html
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