title: Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method.
abstract: BACKGROUND
  The prevalence of chronic kidney disease (CKD) has recently increased, and maintaining high quality of CKD care is a major factor in preventing end-stage renal disease. Here, we developed novel quality indicators for CKD care based on existing electronic health data.
  
  
  METHODS
  We used a modified RAND appropriateness method to develop quality indicators for the care of non-dialysis CKD patients, by combining expert opinion and scientific evidence. A multidisciplinary expert panel comprising six nephrologists, two primary care physicians, one diabetes specialist, and one rheumatologist assessed the appropriateness of potential indicators extracted from evidence-based clinical guidelines, in accordance with predetermined criteria. We developed novel quality indicators through a four-step process: selection of potential indicators, first questionnaire round, face-to-face meeting, and second questionnaire round.
  
  
  RESULTS
  Ten expert panel members evaluated 19 potential indicators in the first questionnaire round, of which 7 were modified, 12 deleted, and 4 newly added during subsequent face-to-face meetings, giving a final total of 11 indicators. Median rate of these 11 indicators in the final set was at least 7, and percentages of agreement exceeded 80 % for all but one indicator. All indicators in the final set can be measured using only existing electronic health data, without medical record review, and 9 of 11 are process indicators.
  
  
  CONCLUSIONS
  We developed 11 quality indicators to assess quality of care for non-dialysis CKD patients. Strengths of the developed indicators are their applicability in a primary care setting, availability in daily practice, and emphasis on modifiable processes.
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University, Yoshida-konoe, Sakyo-ku, Kyoto, Japan.|Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Hikarigaoka 1, Fukushima, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Fukuma
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University, Yoshida-konoe, Sakyo-ku, Kyoto, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Hikarigaoka 1, Fukushima, Japan.
authors.forename: Kakuya
authors.initials: K
authors.lastname: Niihata
authors.affiliation: Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan.
authors.forename: Ken-Ei
authors.initials: KE
authors.lastname: Sada
authors.affiliation: Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-kawaramachi 54, Sakyou-ku, Kyoto, Japan.
authors.forename: Motoko
authors.initials: M
authors.lastname: Yanagita
authors.affiliation: Hatta Medical Clinic, Shugakuin Yakushido 4, Sakyo-ku, Kyoto, Japan.
authors.forename: Tsuguru
authors.initials: T
authors.lastname: Hatta
authors.affiliation: Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Nangaku
authors.affiliation: Kidney Unit, National Fukuoka Higashi Medical Center, Chidori 1-1-1, Koga, Fukuoka, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Katafuchi
authors.affiliation: Department of Nephrology and Rheumatology, Japan Labour Health and Welfare Organization Chubu Rosai Hospital, 1-10-5 Komei, Minato-ku, Nagoya, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Fujita
authors.affiliation: Internal Medicine, Suzu General Hospital, 1-1 Nonoe-Yu, Suzu, Ishikawa, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Koizumi
authors.affiliation: Shichijo Clinic, 29 Sujaku-kitanokuchi-cho, Shimogyo-ku, Kyoto, Japan.
authors.forename: Shunzo
authors.initials: S
authors.lastname: Koizumi
authors.affiliation: Japan Community Health Care Organization (JCHO), Tokyo Takanawa Hospital, Takanawa 3-10-11, Minato-ku, Tokyo, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University, Yoshida-konoe, Sakyo-ku, Kyoto, Japan.|Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Hikarigaoka 1, Fukushima, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. shibagaki@marianna-u.ac.jp.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
mesh_terms: D032921:Consensus; D057225:Data Mining / Q000379:methods*; D003697:Delphi Technique; D057286:Electronic Health Records; D019317:Evidence-Based Medicine / Q000592:standards; D006302:Health Services Research; D006801:Humans; D011320:Primary Health Care / Q000592:standards*; D017064:Process Assessment, Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Administrative claims data; Chronic kidney disease; Quality indicators; Quality of care; RAND