The National Quality Forum (NQF), a not-for-profit, non-partisan organization whose seal of approval is the gold standard for performance measures in the United States, has endorsed the first-ever, facility-level fluid management performance measure to improve patient safety, kidney care quality and patient outcomes for dialysis patients.

The measure, which focuses on safe and adequate fluid removal, was developed by the Kidney Care Quality Alliance (KCQA), a group founded by Kidney Care Partners (KCP), a broad-based coalition of patient advocates, dialysis professionals, care providers, researchers and manufacturers.  KCQA was created in 2005 by KCP as an independent organization with the sole purpose of developing quality measures for use in the dialysis care setting. KCQA is guided by a Steering Committee and has a broad-based membership of leading stakeholders in kidney care.

KCQA’s Steering Committee, co-chaired by KCP Chair Dr. Ed Jones, chief of the renal section at Chestnut Hill Hospital in Philadelphiaand clinical professor of medicine at Temple University Hospital, and Dr. Allen Nissenson, Chief Medical Officer of DaVita HealthCare Partners and Emeritus Professor of Medicine at the David Geffen School of Medicine at the University of California at Los Angeles, guides the process and decision-making in a consensus-building and fully transparent way. All recommendations on measure specifications made by the KCQA are made available for public comment.

“We believe the renal community – and KCQA specifically – is in the best position to create measures that are relevant, practical, and proven to drive better outcomes,” said Dr. Jones.  “NQF endorsement of KCQA’s latest performance measure demonstrates that KCQA’s work, which is based on collaboration and a wealth of knowledge and experience, is valued.”

KCP’s initial launch of the KCQA in 2005 led to the development of quality measures endorsed by NQF.  In 2011-2012, two of these measures were consolidated and re-endorsed as a single NQF-endorsed vascular access measure along with an influenza immunization measure. (KCQA’s vascular access measure also maintained endorsement under the recent NQF project; the influenza immunization measure will be re-reviewed in 2016.)  KCP re-convened KCQA in February 2014 for the purpose of developing new patient-centered, facility-level performance measures addressing ESRD care.

Following a comprehensive review, KCQA approved fluid management as its measure development area for 2014-2015, making this area a priority because it is the most common cause of hospitalizations for dialysis patients. A critical connection between fluid management and morbidity had already been made in a 2010 study published in the Clinical Journal of the American Society of Nephrology (CJASN) involving 25,291 dialysis patients tracked 41,699 care episodes that resulted in inpatient hospitalization, observations or emergency department (ED) visits due to complications primarily from fluid overload, at a cost to the Medicare system of $6,372 per patient or $266 million.

Fluid management involves a very delicate balance monitored by skilled clinicians working closely with patients and dialysis staff during and between dialysis treatments. This balance involves limiting salt and water intake between dialysis treatments. Excess accumulation of fluid leads to heart attacks, high blood pressure, fluid in the lungs and even cardiac arrest.

Next to the removal of catheters, fluid management is one of the most important areas of focus to:

• Improve patient survival; to result in fewer hospital admissions, readmissions, and less ED use;
• improve patient quality of life; and
• reduce health care spending by lessening the burden on the Medicare program and the American taxpayer.

KCQA’s ultrafiltration measure, now designated NQF 2701, was endorsed as part of NQF’s Renal Project, which focused on evaluating measures associated with renal conditions and making recommendations for which measures should be endorsed as national consensus standards. The federal government and many private sector entities use NQF-endorsed measures above all others because of the rigor of the evaluation and consensus process behind them.

“We share the NQF’s desire to continue to raise the quality bar, and we look forward to seeing the improved delivery of care and patient outcomes we expect from the implementation of this new fluid management measure across the kidney community,” said KCQA’s Co-Chairman Dr. Allen Nissenson.