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Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method

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Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

The prevalence of chronic kidney disease (CKD) has recently increased, and maintaining high quality of CKD care is a major factor in preventing end-stage renal disease. Here, we developed novel quality indicators for CKD care based on existing electronic health data.

Methods

We used a modified RAND appropriateness method to develop quality indicators for the care of non-dialysis CKD patients, by combining expert opinion and scientific evidence. A multidisciplinary expert panel comprising six nephrologists, two primary care physicians, one diabetes specialist, and one rheumatologist assessed the appropriateness of potential indicators extracted from evidence-based clinical guidelines, in accordance with predetermined criteria. We developed novel quality indicators through a four-step process: selection of potential indicators, first questionnaire round, face-to-face meeting, and second questionnaire round.

Results

Ten expert panel members evaluated 19 potential indicators in the first questionnaire round, of which 7 were modified, 12 deleted, and 4 newly added during subsequent face-to-face meetings, giving a final total of 11 indicators. Median rate of these 11 indicators in the final set was at least 7, and percentages of agreement exceeded 80 % for all but one indicator. All indicators in the final set can be measured using only existing electronic health data, without medical record review, and 9 of 11 are process indicators.

Conclusion

We developed 11 quality indicators to assess quality of care for non-dialysis CKD patients. Strengths of the developed indicators are their applicability in a primary care setting, availability in daily practice, and emphasis on modifiable processes.

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Acknowledgments

This work was supported by JSPS KAKENHI Grant Number 23390130. We are particularly grateful for the assistance given by Miho Kimachi (Kyoto University) who contributed to guideline review.

Author information

Authors and Affiliations

  1. Department of Healthcare Epidemiology, Kyoto University, Yoshida-konoe, Sakyo-ku, Kyoto, Japan

    Shingo Fukuma, Sayaka Shimizu & Shunichi Fukuhara

  2. Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Hikarigaoka 1, Fukushima, Japan

    Shingo Fukuma, Kakuya Niihata & Shunichi Fukuhara

  3. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan

    Ken-ei Sada

  4. Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-kawaramachi 54, Sakyou-ku, Kyoto, Japan

    Motoko Yanagita

  5. Hatta Medical Clinic, Shugakuin Yakushido 4, Sakyo-ku, Kyoto, Japan

    Tsuguru Hatta

  6. Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan

    Masaomi Nangaku

  7. Kidney Unit, National Fukuoka Higashi Medical Center, Chidori 1-1-1, Koga, Fukuoka, Japan

    Ritsuko Katafuchi

  8. Department of Nephrology and Rheumatology, Japan Labour Health and Welfare Organization Chubu Rosai Hospital, 1-10-5 Komei, Minato-ku, Nagoya, Japan

    Yoshiro Fujita

  9. Internal Medicine, Suzu General Hospital, 1-1 Nonoe-Yu, Suzu, Ishikawa, Japan

    Junji Koizumi

  10. Shichijo Clinic, 29 Sujaku-kitanokuchi-cho, Shimogyo-ku, Kyoto, Japan

    Shunzo Koizumi

  11. Japan Community Health Care Organization (JCHO), Tokyo Takanawa Hospital, Takanawa 3-10-11, Minato-ku, Tokyo, Japan

    Kenjiro Kimura

  12. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Yugo Shibagaki

Authors
  1. Shingo Fukuma
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  2. Sayaka Shimizu
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  3. Kakuya Niihata
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  4. Ken-ei Sada
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  5. Motoko Yanagita
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  7. Masaomi Nangaku
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  8. Ritsuko Katafuchi
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  9. Yoshiro Fujita
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  10. Junji Koizumi
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  11. Shunzo Koizumi
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  12. Kenjiro Kimura
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  13. Shunichi Fukuhara
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  14. Yugo Shibagaki
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Corresponding author

Correspondence to Yugo Shibagaki.

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Conflict of interest

Consultancies: Shingo Fukuma (Kyowa Hakko Kirin), Motoko Yanagita (Astellas), Shunichi Fukuhara (Kyowa Hakko Kirin), Masaomi Nangaku (Kyowa Hakko Kirin, Taisho, GSK, Tanabe-Mitsubishi, Takeda, Astellas, JT), Yugo Shibagaki (Asteras Pharma), Honoraria: Masaomi Nangaku (Kyowa Hakko Kirin, Daiichi-Sankyo, MSD, AstraZeneca, Alexion, GSK, Tanabe-Mitsubishi, Taisho, Chugai, Takeda, Astellas, JT, Bayer, Medical Review), Yugo Shibagaki (Novartis Pharma, Otsuka Pharmaceuticals, Kyowa Hakko Kirin). Sayaka Shimizu, Kakuya Niihata, Ken-ei Sada, Tsuguru Hatta, Ritsuko Katafuchi, Yoshihiro Fujita, Junji Koizumi, Shunzo Koizumi and Kenjiro Kimura have declared no competing interest.

Funding

Yugo Shibagaki (Teijin Pharma, Otsuka Pharmaceuticals, Kyowa Hakko Kirin, Takeda Pharmaceuticals, Baxter Japan, Behringer-Ingelheim, Astrazeneca, Sanwa Chemical), Motoko Yanagita (Astellas, Chugai, Daiichi Sankyo, Fujiyakuhin, Kyowa Hakko Kirin, Mitsubishi Tanabe, MSD, Nippon Boehringer Ingelheim, and Torii), Masaomi Nangaku (Alexion, Kyowa Hakko Kirin, Daiichi-Sankyo, Astellas, Tanabe-Mitsubishi, Takeda).

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Fukuma, S., Shimizu, S., Niihata, K. et al. Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method. Clin Exp Nephrol 21, 247–256 (2017). https://doi.org/10.1007/s10157-016-1274-8

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  • DOI: https://doi.org/10.1007/s10157-016-1274-8

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