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. 2017 Apr;21(2):247-256. doi: 10.1007/s10157-016-1274-8. Epub 2016 May 4.


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.

Keywords: Administrative claims data; Chronic kidney disease; Quality indicators; Quality of care; RAND.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Review

MeSH terms

  • Consensus
  • Data Mining / methods*
  • Delphi Technique*
  • Electronic Health Records*
  • Evidence-Based Medicine / standards
  • Health Services Research
  • Humans
  • Primary Health Care / standards*
  • Process Assessment, Health Care / standards*
  • Quality Assurance, Health Care / standards*
  • Quality Indicators, Health Care / standards*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / therapy*
  • Surveys and Questionnaires
  • Treatment Outcome