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National Healthcare Quality Report, 2007

Effectiveness of Care: End Stage Renal Disease

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Management of End Stage Renal Disease
Dialysis patients registered on waiting list for transplantation
Patients with treated chronic kidney failure who receive a transplant within 3 years of date of renal failure
Hemodialysis patients with urea reduction ratio 65% or higher
Patients with hematocrit 33 or greater or hemoglobin 11 or greater
Standardized mortality ratio for dialysis patients
Hemodialysis patients with arteriovenous fistula as primary mode of vascular access

Management of End Stage Renal Disease

Measure Title

Dialysis patients registered on waiting list for transplantation.

Measure Source

Healthy People 2010.

National Tables

1.33a Percent of dialysis patients registered on the waiting list for transplantation, United States, 1999 and 2003.

National Data Source

National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).

National Denominator

All incident end stage renal disease (ESRD) Medicare patients in the given year who were under age 70 and had a known State of residence in the 50 States or DC. Patients who received a transplant at any time from a live donor were excluded from the measure.

National Numerator

Subset of the denominator population who were registered on the kidney transplant waiting list on December 31 of the measure year or received a deceased-donor kidney within 1 year of their ESRD initiation date.

State Tables

1.33b Percent of dialysis patients registered on the waiting list for transplantation, by State, 1999 and 2003.

State Data Source

NIH, NIDDK, USRDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

The measure was calculated as the percent (by Kaplan-Meier methodology) who were either wait-listed or received a deceased-donor kidney within 1 year of their ESRD initiation date.

This measure is referred to as measure 4-5 in Healthy People 2010 documentation.

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Management of End Stage Renal Disease

Measure Title

Patients with treated chronic kidney failure who receive a transplant within 3 years of date of renal failure.

Measure Source

Healthy People 2010.

National Tables

1.34a Persons receiving a kidney transplant within 3 years of date of renal failure, United States, 1992-1994 and 2001.

National Data Source

National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), United States Renal Data System (USRDS).

National Denominator

All Medicare dialysis patients who initiated therapy in the given year and had a known State of residence in the 50 States or DC, excluding patients with prior kidney transplants and patients over the age of 69.

National Numerator

Subset of the denominator population receiving a transplant within 3 years of renal failure.

State Tables

1.34b Persons receiving a kidney transplant within 3 years of date of renal failure, by State, 1992-1994 and 2001.

State Data Source

NIH, NIDDK, USRDS.

State Denominator

Same as national.

State Numerator

Same as national.

Comments

Note that the Healthy People 2010 measure refers to "with 3 years of registration on a waiting list." Measuring transplants within 3 years of renal failure yields a more complete picture of access to transplantation.

This measure is referred to as measure 4-6 in Healthy People 2010 documentation.

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Management of End Stage Renal Disease

Measure Title

Hemodialysis patients with urea reduction ratio 65% or higher.

Measure Source

University of Michigan Kidney Epidemiology and Cost Center (UMKECC), Unit Specific Report.

National Tables

1.35a Hemodialysis patients with urea reduction ratio 65% or higher, United States, 2002 and 2005.

National Data Source

Centers for Medicare & Medicaid Services (CMS), ESRD Clinical Performance Measures Project.

National Denominator

Medicare hemodialysis patients age 18 and over.

National Numerator

Subset of the denominator population with urea reduction ratio (URR) 65 percent or higher.

State Tables

1.35b Percent of hemodialysis patients with urea reduction ratio 65% or higher, by State, 2000 and 2005.

State Data Source

UMKECC, Unit Specific Report (USR).

State Denominator

Medicare hemodialysis patients.

State Numerator

Subset of the denominator population with urea reduction ratio (URR) 65 percent or higher.

Comments

Standard error was calculated based on sample N, not sampling unit; therefore, reported standard error may be understated.

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Management of End Stage Renal Disease

Measure Title

Patients with hematocrit 33 or greater or hemoglobin 11 or greater.

Measure Source

University of Michigan Kidney Epidemiology and Cost Center (UMKECC), Unit Specific Report.

National Tables

1.36a Hemodialysis patients with hemoglobin 11 gm/dL or higher, United States, 2002 and 2005.

National Data Source

Centers for Medicare & Medicaid Services (CMS), ESRD Clinical Performance Measures Project.

National Denominator

Medicare adult (age 18 and over) in-center hemodialysis (HD) patients or peritoneal dialysis (PD) patients, excluding patients with mean hemoglobin of 12 g/dL or greater who are not prescribed Epoetin at any time during the study period (HD patients: October to December, PD patients: January to March).

National Numerator

Subset of the denominator population with mean hemoglobin of 11g/dL or higher during the study period.

State Tables

1.36b Percent of patients with hematocrit 33 or greater, by State, 2000 and 2005.

State Data Source

UMKECC, Unit Specific Report (USR).

State Denominator

Medicare dialysis patients treated with Erythropoietin.

State Numerator

Subset of the denominator population with hematocrit 33 or greater.

Comments

Previously, the percent of patients in the State with hematocrit of 33% or greater included all patients, but for the 2004 measure, it includes only the Erythropoietin-treated patients. Therefore, 2004 rates may not be comparable with earlier years.

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Management of End Stage Renal Disease

Measure Title

Standardized mortality ratio for dialysis patients.

Measure Source

University of Michigan Kidney Epidemiology and Cost Center (UMKECC), Unit Specific Report.

State Tables

1.37 Standardized mortality ratio for dialysis patients, by State, 2000 and 2005.

State Data Source

UMKECC, Unit Specific Report (USR).

State Denominator

Medicare dialysis patients.

State Numerator

Standardized mortality among the denominator population.

Comments

Standardized mortality ratios (SMRs) are used to compare mortality in annual incident populations over successive years of observation. The death rates are high during the first year of treatment, lower during the second and third years, and rise again after the fourth year.

Note that the Dialysis Facility Compare measure "patient survival rate" is equivalent to the University of Michigan SMR.

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Management of End Stage Renal Disease

Measure Title

Hemodialysis patients with arteriovenous fistula as primary mode of vascular access.

Measure Source

Centers for Medicare & Medicaid Services (CMS), End Stage Renal Disease Clinical Performance Measures Project.

Tables

1.38 Hemodialysis patients with arteriovenous fistula as primary mode of vascular access, United States, 2002 and 2005.

Data Source

CMS, ESRD Clinical Performance Measures Project.

Denominator

(1) Medicare incident adult in-center hemodialysis patients age 18 and over (defined as those patients initiating their most recent course of hemodialysis) or (2) prevalent adult (age 18 and over) hemodialysis patients in the sample for analysis.

Numerator

For (1), the number of incident patients in the denominator who were dialyzed using an arteriovenous fistula during their last hemodialysis treatment. For (2), the number of prevalent patients in the denominator who were dialyzed using an arteriovenous fistula during their last hemodialysis treatment during the study period.

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