Methodological considerations in using patient reported measures in dialysis clinics

John D. Peipert*, Ron D. Hays

*Corresponding author for this work

Research output: Contribution to journalComment/debatepeer-review

15 Scopus citations

Abstract

Patient reported measures (PRMs), including patient-reported outcomes, play a critical role in dialysis care. The usage of PRMs is extensive in dialysis clinics. While there are excellent PRMs to choose from, and their implementation as part of quality improvement and performance monitoring is extensive, there are still methodological challenges to be addressed. In this paper, we identify key methodological concerns around use of PRMs in dialysis centers in the United States and make recommendations for improving the use of PRMs in dialysis related to Selection of PRMs, Mode of Administration, and Support for PRM Use. These recommendations include: (1) Continue the use of Kidney Disease Quality of Life 36-item survey (KDQOL™-36) for dialysis centers’ internal quality improvement activities and the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH-CAHPS survey®) for public dialysis center performance monitoring, but promote efforts to modify these instruments by incorporating PROMIS general health items (KDQOL-36) and reducing the length of the ICH-CAHPS. (2) Adopt a PRM of whether dialysis patients have been informed about all dialysis and transplant options. (3) Evaluate equivalence between electronic and paper versions of PRMs prior to widespread use of electronic administration. (4) Explore reimbursement of costs of PRM administration by the Centers for Medicare and Medicaid Services and kidney organizations. (5) Continue development of provider trainings in PRM administration and interpretation. These recommendations will help dialysis care decision-makers, clinicians, and applied researchers take the next steps toward enhancing PRM use in dialysis.

Original languageEnglish (US)
Article number11
JournalJournal of patient-reported outcomes
Volume1
DOIs
StatePublished - 2017

Funding

The CAHPS In-Center Hemodialysis Survey was supported by the Agency for Health Research and Quality and CMS. CAHPS surveys are based on a definition of patient experience as “the range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities” [24]. CMS has adopted several CAHPS measures for quality improvement in addition to ICH-CAHPS, including the CAHPS Hospital, Home and Community-Based Services, Hospice, Surgery, and Medicare ambulatory surveys. The ICH-CAHPS survey items are targeted at care provided to hemodialysis patients, and these items would not be appropriate for consumers of other types of health services. The ICH-CAHPS includes 3 composites: Nephrologists Communication and Caring, Providing Information to Patients, and Quality of Dialysis Center Care and Operations. Additionally, 3 other items provide global ratings of patients’ experience with their kidney doctors, dialysis center staff, and dialysis center. Support for the reliability and validity of these composites has been provided [25].

Keywords

  • Dialysis
  • Outcomes
  • Patient reported measures

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management

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