Developing a Composite Quality Indicator to Assess The Quality of Care for US Medicare End-stage Renal Disease Patients

Kang, Hye-Young

Journal of Korean Society Quality Assurance Health Care 2000;7(2): 204.
Published online December 30, 2000.

미국 Medicare 투석환자 치료의 질 지표 개발 : 4가지 주요 치료영역을 바탕으로

강혜영

연세대학교 대학원 보건학과

Developing a Composite Quality Indicator to Assess The Quality of Care for US Medicare End-stage Renal Disease Patients

Hye-Young Kang

Department of Public Health, The Graduate School, Yonsei University

Abstract

Background
There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control.
Methods
The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${geq}$ 1.2; (b) hematocrit level ${geq}$ 30%; (c) serum albumin concentration ${geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics.
Results
Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures.
Conclusion
The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

Key words End-stage renal diseases;Hemodialysis;Quality of care;Quality indicator;