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Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators

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Abstract
This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surrogate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some pointers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indicator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain-i.e. subsequent aspects of care connected by evidence-based links-as a starting point for composing a performance indicator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facilities over time.
Keywords
CHRONIC KIDNEY-DISEASE, CLINICAL-PRACTICE GUIDELINES, quality of health care, quality indicators, nephrology, CARDIOVASCULAR OUTCOMES, PERFORMANCE-MEASUREMENT, REPLACEMENT THERAPY, MEDICAL-CARE, DIALYSIS, IMPROVEMENT, ACCOUNTABILITY, PROTEINURIA

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Citation

Please use this url to cite or link to this publication:

Chicago
van der Veer, Sabine N, Wim Van Biesen, Cécile Couchoud, Charles RV Tomson, and Kitty J Jager. 2014. “Measuring the Quality of Renal Care: Things to Keep in Mind When Selecting and Using Quality Indicators.” Nephrology Dialysis Transplantation 29 (8): 1460–1467.
APA
van der Veer, S. N., Van Biesen, W., Couchoud, C., Tomson, C. R., & Jager, K. J. (2014). Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators. NEPHROLOGY DIALYSIS TRANSPLANTATION, 29(8), 1460–1467.
Vancouver
1.
van der Veer SN, Van Biesen W, Couchoud C, Tomson CR, Jager KJ. Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2014;29(8):1460–7.
MLA
van der Veer, Sabine N, Wim Van Biesen, Cécile Couchoud, et al. “Measuring the Quality of Renal Care: Things to Keep in Mind When Selecting and Using Quality Indicators.” NEPHROLOGY DIALYSIS TRANSPLANTATION 29.8 (2014): 1460–1467. Print.
@article{5861669,
  abstract     = {This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surrogate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some pointers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indicator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain-i.e. subsequent aspects of care connected by evidence-based links-as a starting point for composing a performance indicator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facilities over time.},
  author       = {van der Veer, Sabine N and Van Biesen, Wim and Couchoud, C{\'e}cile and Tomson, Charles RV and Jager, Kitty J},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  language     = {eng},
  number       = {8},
  pages        = {1460--1467},
  title        = {Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators},
  url          = {http://dx.doi.org/10.1093/ndt/gft473},
  volume       = {29},
  year         = {2014},
}

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