Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method

• Published in: Clinical and experimental nephrology Vol. 21; no. 2; pp. 247 - 256
• Main Authors: Fukuma, Shingo, Shimizu, Sayaka, Niihata, Kakuya, Sada, Ken-ei, Yanagita, Motoko, Hatta, Tsuguru, Nangaku, Masaomi, Katafuchi, Ritsuko, Fujita, Yoshiro, Koizumi, Junji, Koizumi, Shunzo, Kimura, Kenjiro, Fukuhara, Shunichi, Shibagaki, Yugo
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-04-2017; Springer Nature B.V
• Subjects: Consensus; Data Mining - methods; Delphi Technique; Electronic Health Records; Evidence-Based Medicine - standards; Health Services Research; Humans; Medicine; Medicine & Public Health; Nephrology; Original Article; Primary Health Care - standards; Process Assessment (Health Care) - standards; Quality Assurance, Health Care - standards; Quality Indicators, Health Care - standards; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - therapy; Surveys and Questionnaires; Treatment Outcome; Urology; Administrative claims data; Quality indicators; Chronic kidney disease; RAND; Quality of care
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-016-1274-8

Background
The prevalence of chronic kidney disease (CKD) has recently increased, and maintaining high quality of CKD care is a major factor in preventing end-stage renal disease. Here, we developed novel quality indicators for CKD care based on existing electronic health data.
Methods
We used a modified RAND appropriateness method to develop quality indicators for the care of non-dialysis CKD patients, by combining expert opinion and scientific evidence. A multidisciplinary expert panel comprising six nephrologists, two primary care physicians, one diabetes specialist, and one rheumatologist assessed the appropriateness of potential indicators extracted from evidence-based clinical guidelines, in accordance with predetermined criteria. We developed novel quality indicators through a four-step process: selection of potential indicators, first questionnaire round, face-to-face meeting, and second questionnaire round.
Results
Ten expert panel members evaluated 19 potential indicators in the first questionnaire round, of which 7 were modified, 12 deleted, and 4 newly added during subsequent face-to-face meetings, giving a final total of 11 indicators. Median rate of these 11 indicators in the final set was at least 7, and percentages of agreement exceeded 80 % for all but one indicator. All indicators in the final set can be measured using only existing electronic health data, without medical record review, and 9 of 11 are process indicators.
Conclusion
We developed 11 quality indicators to assess quality of care for non-dialysis CKD patients. Strengths of the developed indicators are their applicability in a primary care setting, availability in daily practice, and emphasis on modifiable processes.