Study examines validity of measures used to assess quality of kidney-related care in the U.S.

Reviewed by Kate Anderton, B.Sc. (Editor)Feb 14 2020

New research examines the validity of measures used to assess the quality of kidney-related care in the United States. The findings, which appear in an upcoming issue of JASN, highlight the shortcomings of these measures and provide insights on how to improve them.

The delivery of kidney-related care is of national importance as chronic kidney disease (CKD) is a common condition. The Trump administration recently proposed the Advancing American Kidney Health initiative to improve kidney-related care. Experts have differing opinions on how to best define and measure the quality of care related to CKD, however. Use of quality metrics- or tools to assess quality- may provide benefits but can also lead to over-testing, over-medication, and other unintended consequences.

To evaluate such tools, a team led by co–first authors Mallika Mendu, MD, MBA (Brigham and Women's Hospital) and Sri Lekha Tummalapalli, MD, MBA (University of California, San Francisco) and senior author Daniel Weiner, MD, MS (Tufts Medical Center) compiled a comprehensive list of quality metrics related to kidney disease from multiple organizations, including the Renal Physicians Association, the National Quality Forum, the National Committee for Quality Assurance, and the Centers for Medicare and Medicaid Services.

The study included 60 quality metrics, including 7 for CKD prevention, 2 for slowing CKD progression, 2 for CKD management, 1 for advanced CKD and kidney replacement planning, 28 for dialysis management, 18 for broad measures, and 2 patient-reported outcome measures. The investigators determined that less than half of the quality metrics were highly valid, and the others fell short because of unclear attribution, inadequate definitions, or discordance with recent evidence. Specifically, 49% of the metrics had high validity, 38% had medium validity, and 13% had low validity.

Also, nearly half of the metrics were related to dialysis management. The researchers advocate for refining existing measures and developing new metrics that better reflect the spectrum of kidney care delivery, and they present a framework as to how to achieve better measures.

This is an important time given the national attention to kidney care delivery and efforts of the current administration to improve kidney care. As such, it is important to make sure that we are measuring high quality kidney disease care accurately and appropriately. Our paper provides an evaluation of existing kidney quality measures to guide providers and policy makers regarding which measures are meaningful and should be utilized to measure quality. We also outline an approach to quality measure development and refinement for kidney disease."

Dr.Mallika Mendu, Brigham and Women's Hospital