Effectiveness of Care: Chronic Kidney Disease

2011 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
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

Chronic Care of End Stage Renal Disease
Adult hemodialysis patients whose primary mode of vascular access is an arteriovenous fistula (AVF)
End stage renal disease (ESRD) patients who visited a nephrologist before renal replacement therapy
 


 

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 2020.

National Tables

3_1_2.1 Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 2000-2007

3_1_2.2a-b Dialysis patients under age 70 who were registered on a waiting list for transplantation, United States, 2007, by:

  1. Race.
  2. Ethnicity.

National Data Source

National Institutes of 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) patients with Medicare who are under the age of 70 and known to reside 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 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 Table

3_1_2.3 Dialysis patients under age 70 who were registered on a waiting list for transplantation, by State, United States, 2000-2007

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 either wait-listed or received a deceased-donor kidney within 1 year of their ESRD initiation date.

This measure is referred to as measure CKD-12 in Healthy People 2020 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 2020.

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, 2000-2005

3_1_3.2a-b Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, United States, 2005, by:

  1. Race.
  2. Ethnicity.

National Data Source

National Institutes of 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. Patients with prior kidney transplants and those over the age of 69 were excluded.

National Numerator

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

State Table

3_1_3.3 Patients with treated chronic kidney failure who received a transplant within 3 years of date of renal failure, by State, United States, 2000-2005

State Data Source

NIH, NIDDK, USRDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

This measure is referred to as measure CKD-13.1 in Healthy People 2020 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 (UM-KECC), Unit Specific Report (USR).

State Table

3_1_4.1 Standardized mortality ratio for dialysis patients, by State, United States, 2000-2009.

State Data Source

UM-KECC, 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, lower during the second and third years, and rise again after the fourth year.

The Medicare Compare measure pertaining to Dialysis Facility, "patient survival rate," is equivalent to the University of Michigan SMR.

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Chronic Care of End Stage Renal Disease

Measure Title

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

Measure Source

Centers for Medicare & Medicaid Services (CMS), End Stage Renal Disease (ESRD), Standard Information Management System (SIMS)

National Tables

3_1_5.1 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, United States, 2008-2010

National Data Source

CMS Fistula First Incident AVF Dataset.

National Denominator

All patients in 18 ESRD networks who began outpatient dialysis in the designated year.

National Numerator

Subset of the denominator who initiated dialysis with an AVF.

State Table

3_1_5.2 New end stage renal disease patients who initiated hemodialysis with an arteriovenous fistula, by State, United States, 2008-2010

State Data Source

Same as national.

State Denominator

All new ESRD patients in 18 ESRD networks who began chronic outpatient dialysis in the designated year.

State Numerator

Same as national.

Comments

Data for 2009 and 2010 were drawn from the SIMS Central Repository on May 17, 2011.

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Chronic Care of End Stage Renal Disease

Measure Title

End stage renal disease (ESRD) patients who visited a nephrologist before renal replacement therapy.

Measure Source

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

National Tables

3_1_6.1 End stage renal disease patients age 18 and over who saw a nephrologist at least 12 months prior to initiation of renal replacement therapy, United States, 2006-2008

3_1_6.1a-b End stage renal disease patients age 18 and over who saw a nephrologist at least 12 months prior to initiation of renal replacement therapy, United States, 2008, by:

  1. Race.
  2. Ethnicity.

National Data Source

NIH, NIDDK, USRDS.

National Denominator

All incident ESRD patients age 18 and over.

National Numerator

Subset of the denominator who saw a nephrologist at least 12 months prior to initiation of renal replacement therapy.

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Current as of March 2012
Internet Citation: Effectiveness of Care: Chronic Kidney Disease: 2011 National Healthcare Quality and Disparities Reports. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/measurespec/kidney.html