Less Than Half of Kidney Disease Quality Metrics Rated Highly Valid

THURSDAY, Feb. 13, 2020 — Less than half of the existing 60 kidney disease quality metrics are rated with high validity, according to a study published online Feb. 13 in the Journal of the American Society of Nephrology.

Mallika L. Mendu, M.D., from Harvard Medical School in Boston, and colleagues compiled a comprehensive list of national kidney quality metrics from established kidney and quality organizations. Their validity was assessed on the basis of criteria from the American College of Physicians: importance, appropriate care, clinical evidence base, clarity of measure specifications, and feasibility and applicability.

Sixty quality metrics were included: seven for chronic kidney disease (CKD) prevention, two for slowing progression of CKD, two for CKD management, one for advanced CKD and kidney replacement planning, 28 for management of dialysis, 18 for broad measures, and two for patient-reported outcome measures. On the basis of defined criteria, the researchers found that 29 of the metrics had high validity, while 23 and eight had medium and low validity, respectively.

“Less than half of current metrics were rated with high validity, largely because of unclear attribution, inadequate definitions and risk adjustment, and discordance with the latest evidence,” the authors write. “We advocate for refinement of existing measures and development of new, well-defined, well-validated ‘measures that matter,’ characterized as reflecting the spectrum of nephrology practice, capturing clinically relevant outcomes, and shifting focus to tools that will drive meaningful improvements in patient-centered care.”

Several authors disclosed financial ties to the pharmaceutical and health care industries; one author disclosed having a patent pending.

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