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Research

Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach

Karen Tu, Lindsay Bevan, Katie Hunter, Jess Rogers, Jacqueline Young and Gihad Nesrallah
January 26, 2017 5 (1) E74-E81; DOI: https://doi.org/10.9778/cmajo.20160113
Karen Tu
Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
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Lindsay Bevan
Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
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Katie Hunter
Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
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Jess Rogers
Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
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Jacqueline Young
Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
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Gihad Nesrallah
Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
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    Indicator rating criteria matrix.

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    Figure 2

    Modified Delphi panel process.

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    Table 1: Results as applied in Electronic Medical Record Administrative data Linked Database (EMRALD)
    Quality indicatorNumeratorDenominatorPercentage
    Prevalence, incidence and mortality
    1. Patients with stage 3 or greater chronic kidney disease who have it documented in their cumulative patient profile*1856684827.1
    Screening, diagnosis & risk factors
    2. Percentage of patients with an initial eGFR < 60 mL/min per 1.73 m2 with an eGFR within 6 months*4068857347.5
    3. Percentage of patients with an initial† eGFR < 60 mL/min per 1.73 m2 with an ACR within 6 months*1400857316.3
    4. Percentage of patients with risk factors for chronic kidney disease (diabetes, hypertension) with an eGFR in the past 18 months23 99832 63773.5
    5. Percentage of patients with risk factors for chronic kidney disease (diabetes, hypertension) with an ACR in the past 18 months929132 63728.5
    Management
    6. Percentage of patients with chronic kidney disease with an eGFR in the past 18 months6190684890.4
    7. Percentage of patients with chronic kidney disease with an ACR in the past 18 months2341684834.2
    8. Percentage of patients with chronic kidney disease with a BP recorded in the past 9 months5692684883.1
    9. Percentage of patients with diabetes and albuminuria (moderately or severely increased ACR ≥ 3 mg/mmol) with a BP recorded in the past 9 months5439632086.1
    10. Percentage of patients with chronic kidney disease with a most recent BP < 140/90 mm Hg, or with chronic kidney disease and diabetes with a most recent BP < 130/80 mm Hg4465684865.2
    11. Percentage of patients with diabetes and albuminuria (moderately or severely increased ACR ≥ 3 mg/mmol) who were prescribed an ACE inhibitor or ARB unless a contraindication or adverse effects are recorded3734499774.7
    12. Percentage of patients with chronic kidney disease who had a serum potassium test 7-30 days after initial ACE inhibitor-ARB prescription*2944496559.3
    13. Percentage of patients with chronic kidney disease with an ACE inhibitor and an ARB prescription on the same day*4868480.7
    14. Percentage of patients with chronic kidney disease and ≥ 1 prescription for NSAIDs*9968481.4
    15. Percentage of patients ≥ 50 years and ≤ 80 years of age with chronic kidney disease taking a statin unless contraindicated2236370160.4
    16. Percentage of patents with chronic kidney disease who received an influenza vaccine in the past year unless contraindicated4493684865.6
    Referral to a specialist
    17. Percentage of patients aged < 80 years with a referral to a nephrologist for eGFR < 30 mL/min per 1.73 m233950866.7

    Note: ACE = angiotensin-converting enzyme, ACR = albumin-creatinine ratio, ARB = angiotensin II receptor blocker, BP = blood pressure, eGFR = estimated glomerular filtration rate, NSAID = nonsteroidal anti-inflammatory drug.

    *Modified to be feasible to measure.

    †First eGFR < 60 mL/min per 1.73 m2 at least 6 months before the load date of the electronic medical record.

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    Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach
    Karen Tu, Lindsay Bevan, Katie Hunter, Jess Rogers, Jacqueline Young, Gihad Nesrallah
    Jan 2017, 5 (1) E74-E81; DOI: 10.9778/cmajo.20160113

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    Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach
    Karen Tu, Lindsay Bevan, Katie Hunter, Jess Rogers, Jacqueline Young, Gihad Nesrallah
    Jan 2017, 5 (1) E74-E81; DOI: 10.9778/cmajo.20160113
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