Mallika L. Mendu
Less than half of currently used kidney disease quality metrics are “highly valid,” according to a structured metric evaluation review conducted by the American Society of Nephrology Quality Committee and subsequently published in JASN. This finding led Mallika L. Mendu, MD, MBA, of Brigham and Women’s Hospital, and colleagues to “advocate for refining existing measures and developing new metrics that better reflect the spectrum of kidney care delivery.”
As Mendu told Healio Nephrology, “Kidney disease is a common condition, affecting 10% of U.S. population, with end-stage kidney failure representing 7% of the Medicare budget. The Trump administration recently proposed the Advancing American Kidney Health initiative, which seeks to improve kidney care by shifting to more patient-centered and outcome-centered care delivery. The need for measuring kidney care delivery quality is more important than ever in this context.”
For the review, researchers included 60 quality metrics related to chronic kidney disease prevention, slowing CKD progression, CKD management, advanced CKD and kidney replacement planning, dialysis management, broad measures and patient-reported outcome measures. Validity was assessed using the American College of Physicians criteria, which considers importance, appropriate care, clinical evidence base, clarity of measure specifications, feasibility and applicability.
They rated less than half of considered kidney disease quality metrics as highly valid (49%), with 38% having medium validity and 13% having low validity. According to Mendu, the others “fell short” because of unclear attribution, inadequate definitions and risk adjustment or discordance with recent evidence. Furthermore, nearly half of the metrics were related to dialysis management, with only two metrics related to patient-reported outcomes and one to kidney replacement planning.
Mendu ML, et al. J Am Soc Nephrol.
“Over the past 2 decades nationally, we have moved toward ‘high-quality’ and ‘high-value’ health care delivery as a goal, and the Affordable Care Act included provisions to help shift care delivery in this direction,” Mendu said. “However, how we define quality of care is important, particularly for kidney disease care.”
She added, “There is a need to have ongoing rigorous evaluation of measures to ensure that they are valid and reflective of how patients optimally should receive care ... 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.”
In a related editorial, Paul M. Palevsky, MD, FASN, of the VA Pittsburgh Healthcare System, wrote the proposed “switch from volume-based to value-based payment” in Advancing American Kidney Health necessitates both defining quality medical care and determining how it should best be assessed. Palevksy commended ASN’s Quality Committee, arguing: “We must move to a new generation of measures that are not limited to easy-to-obtain administrative data but rather, that are fully integrated into care delivery, reliably assess the care that we provide, and help close the performance gaps that are most important to improving the kidney health of our patients.” – by Melissa J. Webb
Mendu ML, et al. J Am Soc Nephrol. 2020;doi:10.1681/ASN.2019090869.
Palevsky PM. J Am Soc Nephrol. 2020;doi:10.1681/ASN.2019111234.
Disclosure: Mendu reports receiving personal fees from Bayer Pharmaceuticals.