Dataset Information

An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis.

ABSTRACT:

Background

Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality.

Objectives

To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and standardization of quality improvement in Canada.

Design

Environmental scan of quality metrics in ICHD, and subsequent indicator evaluation using a modified Delphi approach.

Setting

Canadian ICHD units.

Participants

Sixteen-member pan-Canadian working group with expertise in ICHD and quality improvement.

Measurements

We classified the existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks.

Methods

Each metric was rated by a 5-person subcommittee using a modified Delphi approach based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for additional comments.

Results

We identified 27 metrics that are tracked across 8 provinces, with only 9 (33%) tracked by multiple provinces (ie, more than 1 province). We rated 9 metrics (33%) as "necessary" to distinguish high-quality from low-quality care, of which only 2 were tracked by multiple provinces (proportion of patients by primary access and rate of vascular access-related bloodstream infections). Most (16/27, 59%) indicators assessed the IOM domains of safe or effective care, and none of the "necessary" indicators measured the IOM domains of timely, patient-centered, or equitable care.

Limitations

The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals, with more representation from academic sites.

Conclusions

Quality indicators in Canada mainly focus on safe and effective care, with little provincial overlap. These results highlight current gaps in quality of care measurement for ICHD, and this initial work should provide programs with a starting point to combine highly rated indicators with newly developed indicators into a concise balanced scorecard that supports quality improvement initiatives across all aspects of ICHD care.

Trial registration

not applicable.

SUBMITTER: Blum D

PROVIDER: S-EPMC7727051 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis.

Blum Daniel D Thomas Alison A Harris Claire C Hingwala Jay J Beaubien-Souligny William W Silver Samuel A SA

Canadian journal of kidney health and disease 20201208

<h4>Background</h4>Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality.<h4>Objectives</h4>To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and ...[more]

PMID: 33343910

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Project description:BackgroundQuality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure.ObjectiveWe sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease.DesignEnvironmental scan of quality indicators currently being collected by various organizations.SettingWe assembled a 16-member group from across Canada with expertise in nephrology and quality improvement.PatientsOur scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics.MeasurementsWe categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks.MethodsA 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval.ResultsThe environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as "necessary" to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures).LimitationsOur list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders.ConclusionsOur environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement.Trial registrationNot applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.

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Dataset Information

An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis.

Background

Objectives

Design

Setting

Participants

Measurements

Methods

Results

Limitations

Conclusions

Trial registration

Publications

An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis.

Similar Datasets

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