January 13, 2006
MINUTES
Kidney Care Quality Initiative Pediatrics Work Group
January 13, 2006
Conference Call
Attendees:
Barbara Fivush, Facilitator/Leader
Brad Warady
Eileen Brewer
Kathy Lester, Patton Boggs and Kidney Care Partner
Julie Black, Patton Boggs
Summary
The Kidney Care Quality Initiative (
Approval of Minutes
The Work Group approved the minutes.
Discussion of the Work Groups’ Response to the Pediatric Insertions
Ms. Lester conveyed that the Work Groups agreed that the Pediatric recommendations, as they were initially intertwined into the Recommendation Documents, were not as prominent as they could be if placed at the conclusion of the documents. The Pediatric Work Group members agreed to this format change.
Discussion of the Pay for Performance Recommendations
The Group agreed to change the third sentence in the bullet on page 6 to express that challenges result from the unique Pediatric population, rather than stating that the Pediatric population is smaller. The word “feasibility” will be replace “efficacy” in the second to last line of the paragraph.
Discussion of Quality of Life Recommendations
The Work Group agreed to have a new label and paragraph for the Pediatrics Quality of Life recommendations. Rather than stating that the ASPN is working with CMS to develop appropriate measures, the group agreed to generalize the statement to convey that stakeholders are working in this area.
To express a research agenda, the Work Group agreed to include a sentence stating that CMS should work with the Pediatric kidney community and other stakeholders to develop appropriate measures and tools, building upon research in progress in this area.
Discussion of Clinical Measures Recommendations
The Work Group acknowledged that the majority of the measures compiled were process measures. They noted that K/DOQI is trying to refrain from assigning numbers to measures. The group agreed to add an introductory statement to convey that at present the Pediatric kidney community needs to continue to establish evidence-based guidelines for targets in the Pediatric community.
Throughout all measures, references to CKD will be removed.
For the Anemia Management measure, the Work Group agreed to strike “pre-pubertal” and amend the following phrase to read “children or adolescents.” They also agreed to change the measure to require a hemoglobin level greater than or equal to 11 g/dl.
They agreed to change the Iron Status measure. The TSAT should be checked every month until the target Hgb/Hct is reached, and then it should be checked every three months during stable EPO treatment. Warady will work on making the measure more generic.
The group changed the Immunization measures in several ways. The word adequate will be removed. Mention of MMR will also be removed. The Work Group agreed that second immunization measure should require that the influenza vaccine should be offered, rather than require that it is given annually.
The group agreed to change the title of the PD measure to Peritoneal Dialysis Management.
The Work Group also discussed PD Management, Bone Status, and the Evaluation of Nutritional Status.
The Vascular Access measure was changed to eliminate the goal of 50 percent of patients with an AV fistula. The group reached consensus on adding that patients should be considered for an AV fistula, rather than stating that patients should have an AV fistula or graft.
The group agreed to change the title of the hemodialysis measure to Hemodialysis Management.
Next Steps
Brad Warady will provide the revised Clinical Measures recommendations to Ms. Lester. The revised Clinical Measures table will be circulated with the introduction for approval.
