BACKGROUND Despite growth in value-based payment, attributes of nephrology care associated with payer-defined value remains unexplored. METHODS Using national health insurance claims data from private preferred provider organization plans, we ranked nephrology practices using total cost of care and a composite of common quality metrics. Blinded to practice rankings, we conducted site visits at four highly ranked and three average ranked practices to identify care attributes more frequently present in highly ranked practices. A panel of nephrologists used a modified Delphi method to score each distinguishing attribute on its potential to affect quality and cost of care and ease of transfer to other nephrology practices. RESULTS Compared with average-value peers, high-value practices were located in areas with a relatively higher proportion of black and Hispanic patients and a lower proportion of patients aged >65 years. Mean risk-adjusted per capita monthly total spending was 24% lower for high-value practices. Twelve attributes comprising five general themes were observed more frequently in high-value nephrology practices: preventing near-term costly health crises, supporting patient self-care, maximizing effectiveness of office visits, selecting cost-effective diagnostic and treatment options, and developing infrastructure to support high-value care. The Delphi panel rated four attributes highly on effect and transferability: rapidly adjustable office visit frequency for unstable patients, close monitoring and management to preserve kidney function, early planning for vascular access, and education to support self-management at every contact. CONCLUSIONS Findings from this small-scale exploratory study may serve as a starting point for nephrologists seeking to improve on payer-specified value measures.

中文翻译：

---

探索在价值衡量标准中排名靠前的肾脏科医生的护理属性。

背景尽管基于价值的支付有所增长，但与付款人定义的价值相关的肾脏病护理属性仍未被探索。方法使用来自私人首选提供者组织计划的国家健康保险索赔数据，我们使用总护理成本和综合质量指标对肾脏病学实践进行排名。对实践排名视而不见，我们对四个排名靠前的实践和三个平均排名的实践进行了实地考察，以确定在排名靠前的实践中更频繁地出现的护理属性。一组肾病专家使用改良的德尔菲法对每个区别属性进行评分，以评估其影响护理质量和成本的潜力以及转移到其他肾病学实践的难易程度。结果 与平均值同行相比，高价值实践位于黑人和西班牙裔患者比例相对较高且年龄>65岁患者比例较低的地区。高价值实践的平均风险调整后的人均每月总支出降低了 24%。在高价值肾脏病学实践中更频繁地观察到包含五个一般主题的十二个属性：预防近期代价高昂的健康危机、支持患者自我保健、最大限度地提高就诊效率、选择具有成本效益的诊断和治疗方案以及开发基础设施支持高价值护理。德尔福小组在效果和可转移性方面对四个属性给予了高度评价：为不稳定的患者快速调整就诊频率、密切监测和管理以保持肾功能、早期规划血管通路、和教育，以支持每次接触时的自我管理。结论 这项小规模探索性研究的结果可以作为肾病学家寻求改进付款人指定价值措施的起点。