ESRD Clinical Performance Measures Show Improvements
by Gwen Gampel, NRAA Government Relations Consultant
(What follows is a portion of the Legislation Report that first appeared in the December issue of the National Renal Administrators Association's (NRAA) President's Letter. For information on joining the NRAA and receiving complete print and electronic versions of up-to-the-minute and in-depth reports on all ESRD issues, visit the NRAA web site.)
NRAA members and the renal community can pat themselves on the back for yet again improving� the quality of care in dialysis facilities as measured by the 2000 outcomes data.� In the Centers for Medicare and Medicaid Services� (CMS)� 2001 Annual Report on ESRD Clinical Performance Measures, data shows once again improvements in all key quality of care indicators tracked by CMS.� The findings were released at a meeting attended by NRAA Board members Myra Thomas and Tony Messana.� Among the highlights of the report are:
Adult In-Center Hemodialysis
Hemodialysis Adequacy:
91% of patients on dialysis for 6 months or more and dialyzing three times a week had a mean delivered adequacy dose of Kt/V > 1.2 (HD Adequacy CPM III)
86% of prevalent patients had a mean delivered adequacy dose of Kt/V > 1.2
Median Kt/V was 1.49
82% of patients had a mean URR > 65%
Median URR was 71.4%
Median dialysis session length was 210 minutes
Vascular Access:
27% of incident patients were dialyzed using an AV fistula (AVF) (Vascular Access CPM I)
30% of prevalent patients were dialyzed using an AVE (Vascular Access CPM I)
17% of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer (Vascular Access CPM II)
47% of prevalent patients with an AV graft were routinely monitored for the presence of stenosis (Vascular Access CPM III)
Anemia Management:
38% of targeted patients prescribed Epoetin had a hemoglobin between 11.0-12.0 gm/dL (Anemia Management CPM I)
91% of patients who met the inclusion criteria had a least one measured transferrin saturation value and one serum ferritin concentration value (Anemia Management CPM IIa)
71% of patients who met the inclusion criteria had at least one transferrin saturation >20% and one serum ferritin concentration >100 ng/mL (Anemia Management CPM IIb)
73% of patients who met the inclusion criteria were prescribed intravenous iron in at least one month during the study period (Anemia Management CPM III)
74% of patients had a mean hemoglobin >11 gm/dL
9% of patients had a mean hemoglobin <10.0 gm/dL
Median hemoglobin was 11.7 gm/dL
Median IV Epoetin dose was 63.3 units/kg
Median SC Epoetin dose was 54.8 units/kg
Serum Albumin:
29% of patients had a mean serum albumin >4.0/3.7 gm/dL (BCG/BCP)
80% of patients had a mean serum albumin > 3.5/3.2 gm/dL (BCG/BCP)
Median serum albumin BCG/BCP was 3.8/3.6 gm/dL
Adult Peritoneal Dialysis Patients
Peritoneal Dialysis Adequacy:
85% of patients had a least one measured total solute clearance for urea and creatinine (PD Adequacy CPM I) during the six month study period
62% of patients had their total solute clearance for urea and creatinine calculated in a standard way (PD Adequacy CPM II)
69% of CAPD patients had a mean weekly Kt/Vurea of >2.0 and a mean weekly creatinine clearance >60 L/week/1.73m OR there was evidence the dialysis prescription was changed if the adequacy measurements were below these thresholds during the six month study period (PD Adequacy CPM III)
62% of Cycler patients with a daytime dwell had a mean Kt/Vurea of > 2.1 and a mean weekly creatinine clearance of >63 L/week/1.73m or there was evidence the dialysis prescription was changed if the adequacy measurements were below these thresholds during the six month study period (PD Adequacy CPM III)
64% of Cycler patients without ha daytime dwell had a mean Kt/Vurea of >2.2 and� a mean weekly creatinine clearance of >66 L/week/1.73m or there was evidence the dialysis prescription was changed if the adequacy measurements were below these thresholds during the six month study period (PD Adequacy CPM III)
Median weekly Kt/Vurea for CAPD patients was 2.23
Median weekly Kt/Vurea for Cycler patients with a daytime dwell was 2.24
Median weekly Kt/Vurea for Cycler patients without a daytime dwell was 2.22
Anemia Management:
39% of targeted patients prescribed Epoetin had a mean hemoglobin between 11.0-12.0 gm/dL (Anemia Management CPM I)
72% of patients who met the inclusion criteria had at least two measured transferrin saturation values and two serum ferritin concentration values during the six month study period (Anemia Management CPM IIa)
75% of patients who met the inclusion criteria had at least one transferrin saturation >20 and one serum ferritin concentration >100 ng/mL (Anemia Management CPM IIb)
23% of patients who met the inclusion criteria were prescribed intravenous iron in at least one of the two-month periods during the study period (Anemia Management CPM II)
73 % of patients had a mean hemoglobin ?11 gm/dL
Median hemoglobin was 1l.7 gm/dL
Median SC Epoetin dose was 38.8 units/kg
Median IV Epoetin dose was 62.0 units/kg
Serum Albumin:
14% of patients had a mean serum albumin > 4.0/3.7 gm/dL (BCG/BCP)
56% of patients had a mean serum albumin > 3.5/3.2 gm/dL (BCG/BCP)
Median serum albumin BCG/BCP was 3.6/3.3 gm/dL
Suggestions for Improving Quality
Additionally, the report has information on some special studies that the Clinical Performance Measures Quality Improvement Steering Committee suggested be undertaken by dialysis facilities including:
shared decision making for appropriate initiation and withdrawal of dialysis;
preventing transmission of infections; and
preventative foot care in diabetic patients.
Data Collection Time Frame: The clinical data collected for the 2001 ESRD Clinical Performance Measures Project were from the time period October - December 2000 for the adult in-center hemodialysis patients, October 2000-March 2001 for the adult peritoneal dialysis patients, and October-December 2000 for the pediatric� hemodialysis patients.�� In 2002, CMS will collect data for the ESRD Clinical Performance Measures on a national sample of adult in-center hemodialysis, adult peritoneal dialysis and all pediatric in-center hemodialysis patients (12-18 years old).
The full report and Power Point file containing all of the figures in the report will soon be found at www.hcfa.gov/quality/3m.htm.
[This message has been edited by Gary Peterson (edited 12-26-2001).]
