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  • Measure Summary
  • NQMC:000360
  • Oct 2002

Advanced chronic kidney disease (CKD): percent of patients with documentation that education was provided.

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 that education was provided.

Rationale

Patients with advanced chronic kidney disease (CKD) face important decisions regarding which mode of renal replacement therapy (RRT) they will use. The choice is difficult because the treatments are complicated, involving dietary and fluid restrictions, medication schedules, vascular or peritoneal access placement or transplantation. Predialysis education programs often are aimed not only at informing patients of all treatment options, but also at decreasing anxiety for patients and their families and at providing enhanced self-care strategies. Regardless of whether treatment is transplantation or dialysis, home-based, or dialysis center-based, patients need to acquire knowledge and skills to participate in their treatment. Thus, patient education is an important component in management of advanced chronic kidney disease and may be expected to influence patients' choice of and success with RRT modality.

Most education has focused on choice of modality of RRT (hemodialysis, peritoneal dialysis, or kidney transplant). At least two instruments for measuring knowledge about kidney failure and treatment options have been developed and demonstrate reliability and validity. Pre-RRT education has been shown to improve patients' satisfaction and confidence with modality selection in multiple studies. It may also improve compliance with RRT.

Evidence for Rationale

Ahlmen J, Carlsson L, Schonborg C. Well-informed patients with end-stage renal disease prefer peritoneal dialysis to hemodialysis. Perit Dial Int. 1993;13 Suppl 2:S196-8. PubMed External Web Site Policy

Binik YM, Devins GM, Barre PE, Guttmann RD, Hollomby DJ, Mandin H, Paul LC, Hons RB, Burgess ED. Live and learn: patient education delays the need to initiate renal replacement therapy in end-stage renal disease. J Nerv Ment Dis. 1993 Jun;181(6):371-6. [28 references] PubMed External Web Site Policy

Breckenridge DM. Patients' perceptions of why, how, and by whom dialysis treatment modality was chosen. ANNA J. 1997 Jun;24(3):313-9; discussion 320-1. PubMed External Web Site Policy

Chambers JK, Boggs DL. Development of an instrument to measure knowledge about kidney function, kidney failure, and treatment options. ANNA J. 1993 Dec;20(6):637-42, 650; discussion 6. PubMed External Web Site Policy

Coupe D. Making decisions about dialysis options: an audit of patients' views. EDTNA ERCA J. 1998 Jan-Mar;24(1):25-6, 31. PubMed External Web Site Policy

Devins GM, Binik YM, Mandin H, Letourneau PK, Hollomby DJ, Barre PE, Prichard S. The Kidney Disease Questionnaire: a test for measuring patient knowledge about end-stage renal disease. J Clin Epidemiol. 1990;43(3):297-307. PubMed External Web Site Policy

Devins GM, Hollomby DJ, Barre PE, Mandin H, Taub K, Paul LC, Guttmann R, Binik YM. Long-term knowledge retention following predialysis psychoeducational intervention. Nephron. 2000 Oct;86(2):129-34. PubMed External Web Site Policy

Gordon EJ, Sehgal AR. Patient-nephrologist discussions about kidney transplantation as a treatment option. Adv Ren Replace Ther. 2000 Apr;7(2):177-83. PubMed External Web Site Policy

Groome PA, Hutchinson TA, Prichard SS. ESRD treatment modality selection: which factors are important in the decision?. Adv Perit Dial. 1991;7:54-6. [60 references] PubMed External Web Site Policy

Groome PA, Hutchinson TA, Tousignant P. Content of a decision analysis for treatment choice in end-stage renal disease: who should be consulted. Med Decis Making. 1994 Jan-Mar;14(1):91-7. PubMed External Web Site Policy

Klang B, Bjorvell H, Berglund J, Sundstedt C, Clyne N. Predialysis patient education: effects on functioning and well-being in uraemic patients. J Adv Nurs. 1998;28(1):36-44. PubMed External Web Site Policy

Klang B, Bjorvell H, Clyne N. Predialysis education helps patients choose dialysis modality and increases disease-specific knowledge. J Adv Nurs. 1999 Apr;29(4):869-76. PubMed External Web Site Policy

Klang B, Bjorvell H, Cronqvist A. Patients with chronic renal failure and their ability to cope. Scand J Caring Sci. 1996;10(2):89-95. PubMed External Web Site Policy

Klang B, Clyne N. Well-being and functional ability in uraemic patients before and after having started dialysis treatment. Scand J Caring Sci. 1997;11(3):159-66. [26 references] PubMed External Web Site Policy

Levin A, Lewis M, Mortiboy P, Faber S, Hare I, Porter EC, Mendelssohn DC. Multidisciplinary predialysis programs: quantification and limitations of their impact on patient outcomes in two Canadian settings. Am J Kidney Dis. 1997 Apr;29(4):533-40. PubMed External Web Site Policy

O'Donnell A, Tucker L. Pre-dialysis education. A change in clinical practice. How effective is it. EDTNA ERCA J. 1999 Apr-Jun;25(2):29-32. 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).

Primary Health Components

Advanced chronic kidney disease; education

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 that education was provided

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

Unspecified

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

Person- and Family-centered Care

IOM Care Need

Living with Illness

IOM Domain

Patient-centeredness

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 that education* was provided

*Content of education material should include:

  • Prognosis of the disease
  • Renal replacement therapy (RRT) modality choices
  • Symptoms of uremia
  • Finances or employment

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 that education was provided / 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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