Clinical Performance Measures (CPM)
Annually, the Centers for Medicare & Medicaid Services, with input from the Networks and the renal community, determines the areas to focus Network resources for National quality improvement activities. Historically this activity was known as the “Core Indicator Project.” With the advent of NKF-DOQI and clinical practice guidelines, this activity is now known as the “Clinical Performance Measures” (CPM). Each year, the following will be determined:
- The categories of care to assess, evaluate, and monitor for improvement;
- The targeted ESRD patient population to study; and
- The clinical performance measures on which data will be collected to describe the targeted patient population and care practices.
During each year of the contract, categories of care with clinical performance measures will be selected for review. The following information is as of 2001:
|Category of Care||Clinical Performance Measures (Examples)|
|Adequacy of Dialysis:
Hemodialysis & Peritoneal Dialysis
|Pre and Post BUN Levels
Utilized Dialyzer (HD)
Delivered time on hemodialysis
Pre and Post Patient Weights
Times per week dialyzed (HD)
Delivered time on dialysis (HD)
Delivered BFR @ 60 minutes (HD)
URR and/or Kt/V
Iron Utilization & Iron Studies
|Vascular Access (HD)||Type of access in use for study timeframe
Reason for catheter, if applicable
Catheter used for > 90 days
Routine stenosis screening?
Methods of access monitoring
Type of access in use for first hemodialysis
Date access placed
Type of access in use after 90 days
Lab method utilized for obtaining albumins
Facility abstraction is done on selected patient records for the clinical performance measures for the specified time period . The patient sample is a random selection, via CMS, of patients who were on incenter hemodialysis or peritoneal dialysis during the last quarter of the year.
Each April, the Network forwards CPM data collection forms and instructions, patient sample, and fax response sheet to each facility selected to participate. Each facility abstracts data from patient records and submits forms to the Network office. Each fall, the Network QI staff performs a Data Validation Study (DVS) for the CPM activity. A random patient/facility sample is selected by CMS and then the Network requests patient records be submitted to the Network office for Network data abstraction.
CMS and the Network then analyze performance measures which should be monitored or investigated for opportunities to improve outcomes of care.