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  • Measure Summary
  • NQMC:000359
  • Oct 2002

Advanced chronic kidney disease (CKD): percent of patients with documentation about counseling for increasing physical activity.

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in March 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure assesses the percent of patients with advanced chronic kidney disease (CKD) with documentation about counseling for increasing physical activity.

Rationale

Exercise counseling improves measures of physical functioning and work capacity in non-renally impaired persons, reduces overall mortality, and prevents deterioration in physical functioning.

Physical activity is an important component of health. Physicians are encouraged in several national guidelines to recommend routinely that patients exercise regularly. Although physicians do not typically advise patients about physical activity, they are more likely to counsel patients at high risk for a disease and patients with a known disease. Such counseling has been shown to result in sustained improvements in cardiorespiratory fitness in inactive adults without serious chronic diseases.

In patients on hemodialysis, interventions to increase physical activity have been shown in five studies to improve well-being and exercise capacity. A recent large controlled study showed that exercise training and encouragement can result in improvements in physical functioning in end-stage renal disease (ESRD) patients. Furthermore, even ESRD patients with low levels of physical functioning can benefit from exercise counseling in self-reported and objective measures of physical function. Two prospective studies of hemodialysis patients have shown that physical functioning is highly predictive of hospitalization and mortality, suggesting that exercise training or counseling may result in improved survival through its effect on physical functioning or other physiological outcomes. Exercise training has been reported in two studies to increase hemoglobin levels in hemodialysis patients.

Patients with advanced CKD may be better able than dialysis patients to undertake increased physical activity because usually they have better functional status and less co-morbidity. Furthermore, these patients may benefit more from exercise than patients on renal replacement therapy (RRT), as suggested by one study directly comparing the effects of exercise in pre-dialysis and dialysis patients.

The body of research testing the effect of exercise counseling or training in these patients demonstrates that, as in healthy individuals or dialysis patients, they can increase muscle strength and exercise capacity; however, the studies are too small to detect potential benefits of exercise on other health outcomes.

Exercise counseling studies indicate that improvements in performance-based measures of physical functioning and exercise capacity can occur without resource-intensive supervised exercise therapy. Furthermore, these studies suggest improvements in symptoms and quality of life.

Evidence for Rationale

Bull FC, Schipper EC, Jamrozik K, Blanksby BA. Beliefs and behaviour of general practitioners regarding promotion of physical activity. Aust J Public Health. 1995 Jun;19(3):300-4. PubMed External Web Site Policy

Carney RM, Templeton B, Hong BA, Harter HR, Hagberg JM, Schechtman KB, Goldberg AP. Exercise training reduces depression and increases the performance of pleasant activities in hemodialysis patients. Nephron. 1987;47(3):194-8. [17 references] PubMed External Web Site Policy

Curtin RB, Lowrie EG, DeOreo PB. Self-reported functional status: an important predictor of health outcomes among end-stage renal disease patients. Adv Ren Replace Ther. 1999 Apr;6(2):133-40.

DeOreo PB. Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. Am J Kidney Dis. 1997 Aug;30(2):204-12. [26 references] PubMed External Web Site Policy

Effects of physical activity counseling in primary care: the Activity Counseling Trial: a randomized controlled trial. JAMA. 2001 Aug 8;286(6):677-87. PubMed External Web Site Policy

Eidemak I, Haaber AB, Feldt-Rasmussen B, Kanstrup IL, Strandgaard S. Exercise training and the progression of chronic renal failure. Nephron. 1997;75(1):36-40. [39 references] PubMed External Web Site Policy

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May 16;285(19):2486-97. PubMed External Web Site Policy

Fitts SS, Guthrie MR, Blagg CR. Exercise coaching and rehabilitation counseling improve quality of life for predialysis and dialysis patients. Nephron. 1999 Jun;82(2):115-21. PubMed External Web Site Policy

Fitts SS, Guthrie MR. Six-minute walk by people with chronic renal failure. Assessment of effort by perceived exertion. Am J Phys Med Rehabil. 1995 Jan-Feb;74(1):54-8. [73 references] PubMed External Web Site Policy

Fletcher GF, Balady G, Blair SN, Blumenthal J, Caspersen C, Chaitman B, Epstein S, Sivarajan Froelicher ES, Froelicher VF, Pina IL, Pollock ML. Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, AHA. Circulation. 1996 Aug 15;94(4):857-62. PubMed External Web Site Policy

Goldberg AP, Geltman EM, Gavin JR 3rd, Carney RM, Hagberg JM, Delmez JA, Naumovich A, Oldfield MH, Harter HR. Exercise training reduces coronary risk and effectively rehabilitates hemodialysis patients. Nephron. 1986;42(4):311-6. PubMed External Web Site Policy

Goldberg AP, Geltman EM, Hagberg JM, Gavin JR 3rd, Delmez JA, Carney RM, Naumowicz A, Oldfield MH, Harter HR. Therapeutic benefits of exercise training for hemodialysis patients. Kidney Int Suppl. 1983 Dec;16:S303-9. PubMed External Web Site Policy

Goldberg AP, Hagberg J, Delmez JA, Carney RM, McKevitt PM, Ehsani AA, Harter HR. The metabolic and psychological effects of exercise training in hemodialysis patients. Am J Clin Nutr. 1980 Jul;33(7):1620-8. PubMed External Web Site Policy

Lewis CE, Clancy C, Leake B, Schwartz JS. The counseling practices of internists. Ann Intern Med. 1991 Jan 1;114(1):54-8. PubMed External Web Site Policy

Orleans CT, George LK, Houpt JL, Brodie KH. Health promotion in primary care: a survey of U.S. family practitioners. Prev Med. 1985 Sep;14(5):636-47. PubMed External Web Site Policy

Painter P, Carlson L, Carey S, Paul SM, Myll J. Low-functioning hemodialysis patients improve with exercise training. Am J Kidney Dis. 2000 Sep;36(3):600-8. PubMed External Web Site Policy

Painter P, Carlson L, Carey S, Paul SM, Myll J. Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. Am J Kidney Dis. 2000 Mar;35(3):482-92. PubMed External Web Site Policy

Painter PL, Nelson-Worel JN, Hill MM, Thornbery DR, Shelp WR, Harrington AR, Weinstein AB. Effects of exercise training during hemodialysis. Nephron. 1986;43(2):87-92. PubMed External Web Site Policy

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

Rosen MA, Logsdon DN, Demak MM. Prevention and health promotion in primary care: baseline results on physicians from the INSURE Project on Lifecycle Preventive Health Services. Prev Med. 1984 Sep;13(5):535-48. PubMed External Web Site Policy

The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997 Nov 24;157(21):2413-46. PubMed External Web Site Policy

Wells KB, Lewis CE, Leake B, Schleiter MK, Brook RH. The practices of general and subspecialty internists in counseling about smoking and exercise. Am J Public Health. 1986 Aug;76(8):1009-13. PubMed External Web Site Policy

Wells KB, Lewis CE, Leake B, Ware JE Jr. Do physicians preach what they practice? A study of physicians' health habits and counseling practices. JAMA. 1984 Nov 23-30;252(20):2846-8. PubMed External Web Site Policy

Zabetakis PM, Gleim GW, Pasternack FL, Saraniti A, Nicholas JA, Michelis MF. Long-duration submaximal exercise conditioning in hemodialysis patients. Clin Nephrol. 1982 Jul;18(1):17-22. PubMed External Web Site Policy

Primary Health Components

Advanced chronic kidney disease; physical activity; counseling

Denominator Description

The number of adult patients with advanced chronic kidney disease (CKD), not currently receiving renal replacement therapy

Numerator Description

The number of patients from the denominator with documentation about counseling for increasing physical activity

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)

Additional Information Supporting Need for the Measure

Two prospective studies of hemodialysis patients have shown that physical functioning is highly predictive of hospitalization and mortality, suggesting that exercise training or counseling may result in improved survival through its effect on physical functioning or other physiological outcomes.

Evidence for Additional Information Supporting Need for the Measure

Curtin RB, Lowrie EG, DeOreo PB. Self-reported functional status: an important predictor of health outcomes among end-stage renal disease patients. Adv Ren Replace Ther. 1999 Apr;6(2):133-40.

DeOreo PB. Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. Am J Kidney Dis. 1997 Aug;30(2):204-12. [26 references] PubMed External Web Site Policy

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Adult patients age 18 years and older with chronic kidney disease stage 4 or 5 (glomerular filtration rate [GFR] less than or equal to 30 mL/min/1.73 m2), not currently receiving renal replacement therapy

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
The number of patients from the denominator with documentation about counseling* for increasing physical activity

*Counseling includes documentation regarding discussion with the patient or a formal consultation with a physical therapist or an exercise program.

Exclusions
Unspecified

Numerator Search Strategy

Episode of care

Data Source

Administrative clinical data

Laboratory data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Number of patients with documentation about counseling for increasing physical activity / number of patients with advanced CKD.

Measure Collection Name

Clinical Performance Measures on Appropriate Patient Preparation for Renal Replacement Therapy

Measure Set Name

Counseling and Rehabilitation Recommendations

Submitter

Renal Physicians Association - Medical Specialty Society

Developer

Renal Physicians Association - Medical Specialty Society

Funding Source(s)

Ortho Biotech Products, LP

Composition of the Group that Developed the Measure

W. Kline Bolton, MD, Working Group Chair, University of Virginia School of Medicine, Charlottesville, VA; William F. Owen, Jr., MD, President, RPA, Duke University School of Medicine Durham, NC; Baxter Healthcare Corp., McGaw Park, IL; Dale Singer, MHA, Executive Director, RPA.

Content Experts: Jack Coburn, MD, UCLA School of Medicine, West Los Angeles V.A. Healthcare Center, West Los Angeles, CA; William Haley, MD, Mayo Clinic, Jacksonville, FL; Annamaria Kausz, MD, New England Medical Center, Boston, MA; Adeera Levin, MD, St. Paul's Hospital, Vancouver, BC; William Mitch, MD, University of Texas Medical Branch, Galveston, TX; Patricia Painter, PhD, University of California, San Francisco, CA; Michael Rocco, MD, MSCE, Wake Forest University School of Medicine, Winston-Salem, NC.

Association Representatives: Carolyn Atkins, RN, BS, CCTC, National Kidney Foundation, Medical City Dallas Hospital, Dallas, TX; Shelley Clark, RN, National Renal Administrators Association, FMC North Roanoke Dialysis, Roanoke, VA; Paul Eggers, PhD, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD; Lori Fedje, RD, LD, NKF Council on Renal Nutrition, Pacific Northwest Renal Services, Portland, OR; Richard Goldman, MD, Renal Physicians Association, Renal Medicine Associates, Emeritus Albuquerque, NM; Joel Greer, PhD, Centers for Medicare and Medicaid Services, Baltimore, MD; Richard Lafayette, MD, American Society of Nephrology, Stanford University School of Medicine, Stanford, CA; Eugene Z. Oddone, MD, American College of Physicians - American Society of Internal Medicine, Durham VA Medical Center, Durham, NC; Victoria Norwood, MD, American Society of Pediatric Nephrology, University of Virginia, Charlottesville, VA; Paul M. Palevsky, MD, Forum of ESRD Networks, University of Pittsburgh School of Medicine, VA Pittsburgh Health Care System, Pittsburgh, PA; Sandy Peckens, MSW, NKF Council of Nephrology Social Workers, Merrimack Valley Nephrology, Methuen, MA; Venkateswara Rao, MD, American Society of Transplantation, Hennepin County Medical Center, Minneapolis, MN; Charlotte Thomas Hawkins, PhD, RN, CNN, American Nephrology Nurses Association, Rutgers, The State University of New Jersey, Burlington, NJ; Joseph White, American Association of Kidney Patients.

Methodologists: David B. Matchar, MD, FACP, Director, Duke Center for Clinical Health Policy Research and Co-Director, Duke Evidence-based Practice Center, Durham, NC; Douglas C. McCrory, MD, MHS, Co-Director Duke Evidence-based Practice Center, Durham, NC; Joseph A. Coladonato, MD, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Preston S. Klassen, MD, MHS, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Meenal B. Patwardhan, MD, MHSA, Duke Center for Clinical Health Policy Research and Duke Evidence-based Practice Center, Durham, NC; Donal N. Reddan, MD, MHS, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Olivier T. Rutschmann, MD, MPH, Duke Center for Clinical Health Policy Research, Durham, NC; William S. Yancy, Jr., MD, MHS, Duke University Medical Center, Durham, NC.

Medical Editor: Rebecca N. Gray, DPhil, Duke Evidence-based Practice Center, Durham, NC.

Project Manager and Editor: Emily G. Shurr, MA, Duke Evidence-based Practice Center, Durham, NC.

Financial Disclosures/Other Potential Conflicts of Interest

There were none disclosed.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2002 Oct

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in March 2016.

Source(s)

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

Measure Availability

Source not available electronically.

For more information, contact the Renal Physicians Association (RPA) at 1700 Rockville Pike, Suite 220, Rockville, MD 20852; Phone: 301-468-3515; Fax: 301-468-3511; Web site: www.renalmd.org External Web Site Policy; E-mail: rpa@renalmd.org.

NQMC Status

This NQMC summary was completed by ECRI on May 23, 2003. The information was verified by the Renal Physicians Association on June 17, 2003.

This NQMC summary was retrofitted into the new template on May 6, 2011.

The information was reaffirmed by the measure developer on March 11, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, contact RPA at 1700 Rockville Pike, Suite 220, Rockville, MD 20852; phone: 301-468-3515; fax: 301-468-3511; Web site: www.renalmd.org External Web Site Policy; e-mail: rpa@renalmd.org.

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