The Kidney Care Quality Initiative completed Phase I with the development of a starter set of adult clinical measures and quality of life recommendations. A pediatric workgroup also identified domains for which measures should be developed.
These achievements will serve as the foundation for Phase II.   

Final Ballot Summary and Report

Clinical Measures Work Group
The Clinical Measures Work Group developed a starter set of adult measures. These measures are  based upon existing evidence-based guidelines and CMS clinical performance measures.

Quality of Life/Patient Perspectives Workgroup
Using a review of existing quality of life instruments, peer-reviewed journal articles, and other relevant sources, the Quality of Life/Patient Perspectives Workgroup reached consensus on a starter set of measures to drive quality improvement.

The KCQI was created in 2005 to define, assess, monitor, and reward quality care for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).  The short term goal was to be in a position to deliver to the Centers for Medicare and Medicaid Services (CMS) and to Congress a community-supported recommendation for a pay-for-performance system based upon clinical and quality of life metrics for CKD and ESRD.   In the long term, this initiative is designed to develop the next generation of clinical and quality of life metrics that, when achieved and rewarded, result in significant advances in the health of the CKD and ESRD patient populations.  KCQA has engaged with the National Quality Forum (NQF), whose mission is to “develop and implement a national strategy for health care quality measurement and reporting,” in order to improve the quality of health care for CKD and ESRD patients. 

At the most recent full Alliance meeting, Dr. Barry Straube, Director and Chief Clinical Officer in the CMS Office of Clinical Standards and Quality, provided an update on CMS pay-for-performance initiatives. 

Significance of the National Quality Forum (NQF)

• In 1998, the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry proposed creation of the Forum as part of a national quality improvement agenda
• Through 2006 NQF has endorsed more than 300 measures, indicators, events, and practices

• Diverse stakeholders include key government agencies, such as CMS

• NQF endorsement is recognized by Congress and CMS as the "gold standard" for the measurement of healthcare quality

NQF Process

• The Consensus Development Process (CDP) to guide measure endorsement consists of five principle steps:

–        Project conceptualization and priority setting
–        Project planning
–        Product development
–        Product review
–        Product endorsement or approval

Scope of NQF ESRD Project

• The project will::

–        Project conceptualization and priority setting
–        Project planning
–        Product development
–        Product review
–        Product endorsement or approval

The NQF ESRD Steering Committee and its Technical Advisory Panels met over the course of two months to evaluate more than 40 measures submitted by measure developers.  The NQF Steering Committee recommended the following KCQA measures for time-limited endorsement: Influenza Vaccination in the ESRD Population - Facilities, Patient Education Awareness Quality of Life - Facilities, Patient Education Awareness Quality of Life - Physician, Vascular Access (AV fistula) - Physician, and Vascular Access (Catheter) - Physician.  The NQF released its “National Voluntary Consensus Standards for End Stage Renal Disease Care” draft report and the timeline for consideration of the measures on August 16.  NQF Members and the public will have the opportunity to comment on the report.

NQF ESRD Steering Committee 
NQF National Voluntary Concensus Standards for End State Renal Disease Care Draft Report and Timeline 

CMS Phase III ESRD Clinical Performance Measures in effect
April 1, 2008

In line with its quality improvement efforts, on Thursday, April 17, CMS
posted 26 new ESRD CPMs. The CPMs include the 5 NQF-endorsed measures
developed by KCQA:

• Functional Autogenous AV Fistual Access or referral to vascular surgeon for placement - Clinician Level
• Catheter Vascular Access and referred to vascular for evaluation for a permanent access - Clinician Level
• Influenza Vaccination in the ESRD Population - Facility Level
• Patient Education Awareness - Facility Level
• Patient Education Awareness - Clinician Level

CMS Phase III ESRD Clinical Performance Measures
developed by KCQA

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