title: Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators.
abstract: This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surrogate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some pointers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indicator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain-i.e. subsequent aspects of care connected by evidence-based links-as a starting point for composing a performance indicator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facilities over time.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands European Renal Best Practice (ERBP) Methods Support Team, University Hospital Ghent, Ghent, Belgium.
authors.forename: Sabine N
authors.initials: SN
authors.lastname: van der Veer
authors.affiliation: European Renal Best Practice (ERBP) Methods Support Team, University Hospital Ghent, Ghent, Belgium Renal division, University Hospital Ghent, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: van Biesen
authors.affiliation: REIN Registry, Agence de la biomédecine, Saint Denis la Plaine Cedex, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: The Richard Bright Kidney Unit, Southmead Hospital, Bristol, UK.
authors.forename: Charles R V
authors.initials: CR
authors.lastname: Tomson
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands ERA-EDTA Registry, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D006801:Humans; D009398:Nephrology / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*
keywords: nephrology; quality indicators; quality of health care