title: Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach.
abstract: BACKGROUND
  The detection and management of chronic kidney disease lies within primary care; however, performance measures applicable in the Canadian context are lacking. We sought to develop a set of primary care quality indicators for chronic kidney disease in the Canadian setting and to assess the current state of the disease's detection and management in primary care.
  
  
  METHODS
  We used a modified Delphi panel approach, involving 20 panel members from across Canada (10 family physicians, 7 nephrologists, 1 patient, 1 primary care nurse and 1 pharmacist). Indicators identified from peer-reviewed and grey literature sources were subjected to 3 rounds of voting to develop a set of quality indicators for the detection and management of chronic kidney disease in the primary care setting. The final indicators were applied to primary care electronic medical records in the Electronic Medical Record Administrative data Linked Database (EMRALD) to assess the current state of primary care detection and management of chronic kidney disease in Ontario.
  
  
  RESULTS
  Seventeen indicators made up the final list, with 1 under the category Prevalence, Incidence and Mortality; 4 under Screening, Diagnosis and Risk Factors; 11 under Management; and 1 under Referral to a Specialist. In a sample of 139 993 adult patients not on dialysis, 6848 (4.9%) had stage 3 or higher chronic kidney disease, with the average age of patients being 76.1 years (standard deviation [SD] 11.0); 62.9% of patients were female. Diagnosis and screening for chronic kidney disease were poorly performed. Only 27.1% of patients with stage 3 or higher disease had their diagnosis documented in their cumulative patient profile. Albumin-creatinine ratio testing was only performed for 16.3% of patients with a low estimated glomerular filtration rate (eGFR) and for 28.5% of patients with risk factors for chronic kidney disease. Family physicians performed relatively better with the management of chronic kidney disease, with 90.4% of patients with stage 3 or higher disease having an eGFR performed in the previous 18 months and 83.1% having a blood pressure recorded in the previous 9 months.
  
  
  CONCLUSIONS
  We propose a set of measurable indicators to evaluate the quality of the management of chronic kidney disease in primary care. These indicators may be used to identify opportunities to improve current practice in Canada.
authors.affiliation: Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.affiliation: Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Bevan
authors.affiliation: Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
authors.forename: Katie
authors.initials: K
authors.lastname: Hunter
authors.affiliation: Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
authors.forename: Jess
authors.initials: J
authors.lastname: Rogers
authors.affiliation: Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Young
authors.affiliation: Institute for Clinical Evaluative Sciences (Tu, Young), Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto; Centre for Effective Practice (Bevan); Faculty of Medicine (Hunter, Rogers), University of Toronto; Nephrology Program (Nesrallah), Humber River Hospital; Keenan Research Centre (Nesrallah), The Li Ka Shing Knowledge Institute, Toronto, Ont.
authors.forename: Gihad
authors.initials: G
authors.lastname: Nesrallah