BACKGROUND Leveraging quality metrics can be a powerful approach to identify substantial performance gaps in kidney disease care that affect patient outcomes. However, metrics must be meaningful, evidence-based, attributable, and feasible to improve care delivery. As members of the American Society of Nephrology Quality Committee, we evaluated existing kidney quality metrics and provide a framework for quality measurement to guide clinicians and policy makers. METHODS We compiled a comprehensive list of national kidney quality metrics from multiple established kidney and quality organizations. To assess the measures' validity, we conducted two rounds of structured metric evaluation, on the basis of the American College of Physicians criteria: importance, appropriate care, clinical evidence base, clarity of measure specifications, and feasibility and applicability. RESULTS We included 60 quality metrics, including seven for CKD prevention, two for slowing CKD progression, two for CKD management, one for advanced CKD and kidney replacement planning, 28 for dialysis management, 18 for broad measures, and two patient-reported outcome measures. We determined that on the basis of defined criteria, 29 (49%) of the metrics have high validity, 23 (38%) have medium validity, and eight (13%) have low validity. CONCLUSIONS We rated less than half of kidney disease quality metrics as highly valid; the others fell short because of unclear attribution, inadequate definitions and risk adjustment, or discordance with recent evidence. Nearly half of the metrics were related to dialysis management, compared with only one metric related to kidney replacement planning and two related to patient-reported outcomes. We advocate refining existing measures and developing new metrics that better reflect the spectrum of kidney care delivery.

中文翻译：

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衡量肾脏护理质量：评估现有质量指标和促进改善护理质量的方法。

背景技术利用质量度量标准可以是识别影响患者预后的实质性疾病差距的有效方法。但是，指标必须有意义，基于证据，可归因且可行，才能改善护理质量。作为美国肾脏病学会质量委员会的成员，我们评估了现有的肾脏质量指标并提供了质量测量框架，以指导临床医生和政策制定者。方法我们从多个已建立的肾脏和质量组织汇总了国家肾脏质量指标的综合清单。为了评估这些措施的有效性，我们根据美国医师学院的标准进行了两轮结构化的指标评估：重要性，适当的护理，临床证据基础，措施规格的明确性，可行性和适用性。结果我们纳入了60项质量指标，其中包括7项CKD预防，2项CKD减缓，2项CKD管理，1项高级CKD和肾脏替代计划，28项透析管理，18项广泛措施以及2项患者报告的结局指标。我们根据定义的标准确定，29个指标（49％）具有较高的有效性，23个（38％）具有中等有效性，8个（13％）具有较低的有效性。结论我们认为只有不到一半的肾脏疾病质量指标有效。其他原因则是由于归因不明确，定义和风险调整不充分或与最近的证据不一致而导致的。几乎一半的指标与透析管理有关，与之相比，只有一项与肾脏替代计划有关，而两项与患者报告的结局有关。我们主张完善现有措施并开发新指标，以更好地反映肾脏护理服务的范围。