title: Development and initial validation of prescribing quality indicators for patients with chronic kidney disease.
abstract: Quality assessment is a key element for improving the quality of care. Currently, a comprehensive indicator set for measuring the quality of medication treatment in patients with chronic kidney disease (CKD) is lacking. Our aim was to develop and validate a set of prescribing quality indicators (PQIs) for CKD care, and to test the feasibility of applying this set in practice.
  
  
  
  Potential indicators were based on clinical practice guidelines and evaluated using the RAND/UCLA Appropriateness Method. This is a structured process in which an expert panel assesses the validity of the indicators. Feasibility was tested in a Dutch primary care database including >4500 diabetes patients with CKD.
  
  
  
  An initial list of 22 PQIs was assessed by 12 experts. After changing 10 PQIs, adding 2 and rejecting 8, a final list of 16 indicators was accepted by the expert panel as valid. These PQIs focused on the treatment of hypertension, albuminuria, mineral and bone disorder, statin prescribing and possible unsafe medication. The indicators were successfully applied to measure treatment quality in the primary care database, but for some indicators the number of eligible patients was too small for reliable calculation. Results showed that there was room for improvement in the treatment quality of this population.
  
  
  
  We developed a set of 16 PQIs for measuring the quality of treatment in CKD patients, which had sufficient content and face validity as well as operational feasibility. These PQIs can be used to point out priority areas for improvement.
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Kirsten P J
authors.initials: KP
authors.lastname: Smits
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Grigory
authors.initials: G
authors.lastname: Sidorenkov
authors.affiliation: Diabetes Centre, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Henk J G
authors.initials: HJ
authors.lastname: Bilo
authors.affiliation: Dutch College of General Practitioners (NHG), Utrecht, The Netherlands.
authors.forename: Margriet
authors.initials: M
authors.lastname: Bouma
authors.affiliation: Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frans J
authors.initials: FJ
authors.lastname: van Ittersum
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jaco
authors.initials: J
authors.lastname: Voorham
authors.affiliation: Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Denig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D055815:Young Adult
keywords: chronic kidney disease; drug therapy; inappropriate prescribing; quality indicators; quality of health care