Developing Quality Indicators for In-Center Hemodialysis Patients

Purpose:This study was a pilot study to develop structure, clinical performance and outcome measurement and criteria for increasing number of dialysis facilities and patients to provide quality of care. Methods:The six components of developing quality indicators for hemodialysis were as follows: 1) Organizing expert panel members. 2) Selecting the area: to reflect stakeholders' opinion, structured interviews were done. And literature reviews were performed to investigate guidelines and quality measurements of foreign countries. 3) Selecting clinical performance indicators: From experts' opinions and literature review. 4) Developing candidate indicators. 5) Performing demonstration survey: Systemic sampling was performed and 43 facilities were participated in self-answered medical record survey. 6) Based on preliminary evaluation model, final indicators were selected from expert panel reviews. Results:Eleven measures of structure, thirteen performance measures of process and nine monitoring measures of outcome were developed based on literature review and clinical practice guideline. As for criterion-related validity, those of process and outcome were most high and in case of face validity, those of structure and process were most high. The most valid quality indicators were the rate of internal medicine specialist, dialysis frequency per doctor, whether or not keeping emergency equipment, examination of water quality, hemodialysis adequacy (Kt/V), monitoring arterial venous graft for stenosis maintenance of iron storage, and administration of supplemental iron. Conclusion:By developing quality indicators of hemodialysis and performing demonstration evaluation, quality of care for hemodialysis patients is expected to be improved, so as to promote hemodialysis patients' health and improve on quality of life.