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  • Measure Summary
  • NQMC:011398
  • Sep 2015
  • NQF-Endorsed Measure

End stage renal disease (ESRD): percentage of patient-months of pediatric (less than 18 years) in-center hemodialysis, home hemodialysis, and peritoneal dialysis patients who have monthly measures for hemoglobin during the reporting period.

Centers for Medicare & Medicaid Services (CMS). Measure information form: anemia. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2015 Sep 25. 5 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patient-months of pediatric (less than 18 years) in-center hemodialysis, home hemodialysis, and peritoneal dialysis patients who have monthly measures for hemoglobin during the reporting period.

Rationale

Prior studies show a high prevalence of anemia in the pediatric end stage renal disease (ESRD) population. Studies suggest that among chronic kidney disease (CKD) pediatric patients, anemia is associated with adverse outcomes including increased mortality risk and hospitalizations. Therefore, routine measurement of hemoglobin levels and early management of anemia if present, are critical in this population.

Evidence for Rationale

National Quality Forum measure information form: monthly hemoglobin measurement for pediatric patients. Washington (DC): National Quality Forum (NQF); 2016 Dec 23. various p.

Primary Health Components

End stage renal disease (ESRD); hemodialysis (HD); peritoneal dialysis (PD); hemoglobin

Denominator Description

All patient-months for pediatric (less than 18 years old) in-center hemodialysis, home hemodialysis, and peritoneal dialysis patients under the care of the dialysis facility for the entire reporting month (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patient-months of pediatric (less than 18 years old) in-center hemodialysis, home hemodialysis, and peritoneal dialysis patients with a measurement of hemoglobin during the reporting period (see the related "Numerator Inclusions/Exclusions" field)

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
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Reliability Testing

Method of Reliability Testing

The developer used January 2013–December 2013 CROWNWeb data to calculate facility level monthly and annual performance scores. Fifty-nine facilities that had at least 11 eligible patients were included in the testing. There were a total of 1,280 patients. The developer assessed reliability by calculating facility-level Pearson correlation coefficients between the current performance month and the preceding month for reporting months during January 2013–December 2013.

In addition, the developer calculated inter-unit reliability (IUR) for each reporting month and the overall 12 months. The monthly based measure was a simple average across individuals in the facility. The NQF-recommended approach for determining measure reliability is a one-way analysis of variance (ANOVA), in which the between and within facility variation in the measure is determined. The IUR measures the proportion of the measure variability that is attributable to the between-facility variance. The yearly based measure, however, is not a simple average and the developer instead estimates the IUR using a bootstrap approach, which uses a resampling scheme to estimate the within facility variation that cannot be directly estimated by ANOVA. The developer notes that the method for calculating the IUR was developed for measures that are approximately normally distributed across facilities. Since this measure is not normally distributed, the IUR value should be interpreted with some caution.

Statistical Results from Reliability Testing

The Pearson correlation coefficients of each pair of the current and the preceding months ranged from 0.78 to 0.98. All were statistically significant (p less than 0.0001), indicating this measure is reliable over time.

For reliability, the developer calculated the monthly and annual IUR across the 12 reporting months. As explained above, the method for calculating the IUR was developed for measures that are approximately normally distributed across facilities. IUR=0.96, which is high and suggests 96% of variation in the measure is attributed to between facility variation.

Interpretation

The Pearson correlation coefficients were moderate to strong, indicating this measure is reliable over time periods of measurement.

The IUR suggest this measure is reliable. However, since the distribution of performance scores is skewed, the IUR value should be interpreted with some caution.

Validity Testing

Method of Validity Testing

The developer used January 2013–December 2013 CROWNWeb data to calculate facility level monthly and annual performance scores. Fifty-nine facilities that had at least 11 eligible patients and included 1,280 patients in total were included in the testing.

The developer computed the Spearman correlation to assess the association between the annual performance scores and the NQF-endorsed (0369) standardized mortality ratio (SMR) using the 2013 SMR. The data source and the methodology in SMR calculations are attached.

This measure is being maintained on the basis of face validity. The measurement of hemoglobin as a dialysis quality measure was initially developed and approved by a clinical technical expert panel (TEP), which agreed that this quality measure is important in the assessment of the quality of care for pediatric dialysis patients.

Statistical Results from Validity Testing

Spearman correlation coefficient was -0.20, p=0.13.

Interpretation

The result suggests that facilities with a higher percentage of pediatric patients (calculated as patient-months) with hemoglobin measured is associated with a lower risk of mortality relative to facilities with a lower percentage of pediatric patients with hemoglobin measured. The result is however not statistically significant. This may be due to the small sample size (e.g., small number of facilities eligible for this measure).

Evidence for Extent of Measure Testing

National Quality Forum measure information form: monthly hemoglobin measurement for pediatric patients. Washington (DC): National Quality Forum (NQF); 2016 Dec 23. various p.

State of Use

Current routine use

Current Use

External oversight/Medicare

Internal quality improvement

Measurement Setting

Ambulatory Procedure/Imaging Center

Hospital Outpatient

Managed Care Plans

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age less than 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

The reporting month

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patient-months for pediatric (less than 18 years old) in-center hemodialysis, home hemodialysis, and peritoneal dialysis patients under the care of the dialysis facility for the entire reporting month

Patients are included in the facility calculation if "Admit Date" to the specified facility is prior or equal to the first day of the study period, AND the patient has not been discharged ("Discharge Date" is null or blank), OR "Discharge Date" from the facility is greater than or equal to the last day of the study period. The patient's age will be determined by subtracting the patient's date of birth from the first day of the reporting month. All patients under the facility's care for the entire calendar month and are less than 18 years of age will be included in the denominator.

Exclusions
Exclusions that are implicit in the denominator definition include all patients greater than or equal to 18 years and those who have not been in the facility the entire reporting month (transient patients). There are no additional exclusions for this measure.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patient-months of pediatric (less than 18 years old) in-center hemodialysis, home hemodialysis, and peritoneal dialysis patients with a measurement of hemoglobin during the reporting period. The hemoglobin value reported for the end of each reporting month (end-of-month hemoglobin) is used for the calculation.

The numerator will be determined by counting all patient-months in the denominator that include values for 'Hemoglobin' and 'Hemoglobin Collection Date.' A valid hemoglobin value is defined as between 5 and 20 g/dL.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Registry data

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

Does not apply to this measure

Standard of Comparison

Internal time comparison

Original Title

Monthly hemoglobin measurement for pediatric patients.

Measure Collection Name

End Stage Renal Disease (ESRD) Quality Measures

Submitter

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Developer

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Funding Source(s)

Centers for Medicare & Medicaid Services (CMS)

Composition of the Group that Developed the Measure

The Centers for Medicare & Medicaid Services (CMS) has contracted with the University of Michigan Kidney Epidemiology and Cost Center (UM-KECC) to develop measures of anemia in end stage renal disease (ESRD) patients.

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Endorser

National Quality Forum

NQF Number

1424

Date of Endorsement

2015 Dec 2

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Sep

Measure Maintenance

Annually

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

Centers for Medicare & Medicaid Services (CMS). Measure information form: anemia. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2015 Sep 25. 5 p.

Measure Availability

Source available from the Dialysis Data Web site External Web Site Policy.

For more information, contact Casey Parrotte at the Kidney Epidemiology and Cost Center, The University of Michigan, 1415 Washington Heights, Suite 3645 SPHI, Ann Arbor, MI 48109-2029; Phone: 734-763-6611; Fax: 734-763-4004; Email: parrotte@med.umich.edu.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 22, 2018. The information was not verified by the measure developer.

Copyright Statement

No copyright restrictions apply.

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