KCP : Kidney Care Quality Initiative Accomplishments

KIDNEY CARE QUALITY INITIATIVE (KCQI)
ACCOMPLISHMENTS

The KCQI was created in 2005 to define, assess, monitor, and reward quality care for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The short-term goal was to be in a position to deliver to CMS and Congress a community-supported recommendation for a pay-for-performance system based on clinical and quality of life metrics for CKD and ESRD. The initiative was also designed to develop the next generation of clinical and quality of life metrics that, when achieved, can result in significant advances in the health of the CKD and ESRD patient populations.

The Kidney Care Quality Initiative completed Phase I with the development of a starter set of adult clinical measures and quality of life recommendations. A pediatric workgroup also identified domains for which measures should be developed.

Final Ballot Summary and Report

Clinical Measures Work Group
The Clinical Measures Work Group developed a starter set of adult measures. These measures were based on existing evidence-based guidelines and the Centers for Medicare and Medicaid Services’ (CMS) clinical performance measures.

Quality of Life/Patient Perspectives Workgroup
Using a review of existing quality of life instruments, peer-reviewed journal articles, and other relevant sources, the Quality of Life/Patient Perspectives Workgroup reached consensus on a starter set of measures in this area.

THE NATIONAL QUALITY FORUM (NQF)

KCQA is a Member of the National Quality Forum (NQF), whose mission is to “develop and implement a national strategy for healthcare quality measurement and reporting” in order to improve the quality of healthcare for CKD and ESRD patients. The history and significance of NQF is summarized below:

• In 1998, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry proposed creation of the Forum as part of a national quality improvement agenda.
• Through 2008, NQF has endorsed more than 500 measures, indicators, events, and practices.
• Diverse stakeholders include key government agencies, such as CMS
• NQF endorsement is recognized by Congress and CMS as the "gold standard" for the measurement of healthcare quality

NQF Process

Following a project’s conceptualization, prioritization, and planning, NQF’s Consensus Development Process (CDP) to guide measure endorsement consists of five principle steps::

• Consensus standard development
• Widespread review
• Member voting
• Consensus Standards Approval Committee action and Board of Directors endorsement
• Evaluation

Scope of NQF ESRD Project

The objective of NQF’s ESRD project, which concluded in September 2008, was to endorse a set of consensus standards “relevant to the care of patients with ESRD who require dialysis or kidney transplantation for the purposes of public reporting and quality.”NQF’s ESRD Steering Committee and its Technical Advisory Panels met over the course of two months to evaluate more than 40 measures submitted by measure developers, including KCQA. Ultimately, NQF endorsed 25 measures in the following areas:

• anemia
• dialysis adequacy
• vascular access
• mineral metabolism
• influenza vaccination
• mortality and
• patient education, satisfaction, and quality of life.

NQF endorsed the following KCQA measures:

• Influenza Vaccination in the ESRD Population (facility level)
• Patient Education Awareness (facility level)
• Patient Education Awareness (physician level)
• Vascular Access, Functional AV Fistula or Referral to Vascular Surgeon for Placement(physician level)
• Catheter Vascular Access and Referred to Vascular for Evaluation for Permanent Access (physician level)

NQF has published the results of this work in National Voluntary Consensus Standards for End Stage Renal Disease Care.

Detailed Specifications for KCQA’s NQF-Endorsed Measures

NQF's Influenza Vaccination Recommendations for ESRD Patients

Following the conclusion of the ESRD project, the NQF Immunization Steering Committee recommended that all endorsed influenza vaccination measures be aligned across patient populations and healthcare settings. To that end, the Steering Committee recommended several modifications to the KCQA’s “Influenza Immunization in the ESRD Population” measure, which received 2-year time-limited endorsement from NQF in November 2007. NQF Members and the public had an opportunity to comment on the report, and measure developers were offered an opportunity to respond to the recommendations. The KCQA Steering Committee’s response can be accessed below.

KCQA Steering Committee Response Letter

CMS Phase III ESRD Clinical Performance Measures (CPMs), in Effect April 1, 2008

As a part of its quality improvement efforts, CMS announced 26 new ESRD CPMs in April 2008. The CPMs include the five NQF-endorsed measures developed by KCQA listed above.
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