Sugarman Jonathan R, Frederick Pamela R, Frankenfield Diane L, Owen William F, McClellan William M
Qualis Health, Seattle, WA 98133, USA.
Am J Kidney Dis. 2003 Oct;42(4):806-12. doi: 10.1016/s0272-6386(03)00867-9.
The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Clinical Practice Guidelines established a widely accepted set of recommendations for high-quality dialysis care. To enhance the End-Stage Renal Disease Core Indicators Project, an ongoing effort to assess and improve dialysis care in the United States, the Centers for Medicare and Medicaid Services (CMS) commissioned a project to develop clinical performance measures (CPMs) based on the NKF-DOQI guidelines.
The CMS contracted with Qualis Health, a private nonprofit organization serving as a Medicare Quality Improvement Organization, to facilitate a 9-month project to develop dialysis CPMs with the participation of a broad range of stakeholders from the renal community. Work groups were established to develop CPMs addressing 4 areas: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access management, and anemia management. The NKF-DOQI guidelines were prioritized based on the strength of the evidence supporting the guidelines, the feasibility of developing performance measures, and the significance of the areas addressed to the quality of care delivered to dialysis patients. Expert panels developed data specifications, sampling approaches, data-collection tools, and analytic strategies.
Sixteen CPMs were developed based on 22 of 114 NKF-DOQI guidelines. After establishing reliability through field-testing of data-collection instruments, the CPMs were applied to a sample of 8,838 randomly selected hemodialysis patients and 1,650 randomly selected adult peritoneal dialysis patients in summer 1999.
The development of CPMs based on the NKF-DOQI Clinical Practice Guidelines for dialysis care was accomplished in a timely and effective manner by engaging a broad range of stakeholders and technical experts. The CPMs are important tools to assess and improve the quality of dialysis care in the United States. Few comparable efforts exist in other fields of medicine.
美国国家肾脏基金会透析预后质量倡议（NKF-DOQI）临床实践指南制定了一套被广泛接受的高质量透析治疗建议。为加强终末期肾病核心指标项目（一项旨在评估和改善美国透析治疗的持续性工作），医疗保险和医疗补助服务中心（CMS）委托开展了一个项目，以根据NKF-DOQI指南制定临床绩效指标（CPM）。
CMS与Qualis Health（一家作为医疗保险质量改进组织的私人非营利组织）签约，推动一个为期9个月的项目来制定透析CPM，肾领域的广泛利益相关者参与其中。成立了多个工作组来制定涉及4个领域的CPM：血液透析充分性、腹膜透析充分性、血管通路管理和贫血管理。根据支持指南的证据强度、制定绩效指标的可行性以及所涉及领域对透析患者提供的护理质量的重要性，对NKF-DOQI指南进行了优先排序。专家小组制定了数据规范、抽样方法、数据收集工具和分析策略。
基于114条NKF-DOQI指南中的22条制定了16项CPM。在通过数据收集工具的现场测试确定可靠性后，这些CPM于1999年夏季应用于8838名随机选择的血液透析患者和1650名随机选择的成年腹膜透析患者样本。
通过吸引广泛的利益相关者和技术专家，及时有效地完成了基于NKF-DOQI透析护理临床实践指南的CPM制定。这些CPM是评估和改善美国透析护理质量的重要工具。医学的其他领域很少有类似的举措。
