What are CPMs?
History of CPMs
Development
Prioritizing the K-DOQI Guidelines
The Clinical Performance Measures (CPM) Project is a national endeavor conducted annually. The sample for the adult hemodialysis cohort is randomly selected in sufficient size to develop Network-specific estimates on adequacy, anemia management, serum albumin and vascular access CPMs. The findings are representative on the national and Network level, but the size is insufficient to be representative at the state and facility level. The adult peritoneal sample is also randomly selected, but yields findings that are representative only on the national level. Data from all patients ages 12-18 are included and reported at a national level. Get additional information about and data from the Clinical Performance Measures (CPM) Project .
In early August 2007, facilites were notified that the Centers for Medicare & Medicaid Services (CMS) had released the 2006 Annual CPM Report on their web site for download. If you have not reviewed the report, you may download it here, along with the 2005 report. The 2008 study is currently underway, and the 2007 Annual Report will be released later this year.
2006 ESRD Clinical Performance Measures Annual Report (PDF)
2005 ESRD Clinical Performance Measures Annual Report (PDF)
CPM Project Results: Network 5 Performance 2005
What are CPMs?
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Clinical Performance Measures (CPMs) are methods to monitor the extent to which the actions of a health care provider conform to clinical practice guidelines.
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Primarily derived for population based quality improvement.
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In aggregate, the CPMs will assist CMS in assessing the quality of dialysis services provided to Medicare beneficiaries.
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This National Performance Measurement System replaced the ESRD Core Indicator Project in 1999.
History of CPMs
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The Balanced Budget Act requires CMS to develop a method for measuring & reporting the quality of renal dialysis services covered by Medicare.
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To meet the requirement, CMS contracted with PRO-West to develop clinical performance measures based on selected K-DOQI Guidelines.
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A broad cross-section of stakeholders from the renal community was involved.
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Expert workgroups addressed each area covered by K-DOQI Guidelines.
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The project was initiated on an accelerated timetable from contract award in April 1998 to final report in January 1999.
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Development
Using a modified version of the method described by the Agency for Health Care Policy & Research, 16 CPMs were developed. Numerators, denominators, review criteria, data collection tools, data sources & exclusion criteria were specified for each CPM.
Hemodialysis Adequacy
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Measure delivered hemodialysis dose monthly Method to measure dose of delivered hemodialysis Minimum delivered hemodialysis dose Method of post-dialysis BUN sampling
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Measuring baseline total cell volume in dialyzers intended for reuse
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Measuring total solute clearance at regular intervals Calculate weekly Kt/V urea & creatinine clearance in a standard way
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Delivered dose of peritoneal dialysis
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Maximize placement of AVF Minimize catheters as chronic access Preferred/non-preferred location of HD catheters above the waist
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Monitoring A-V grafts for stenosis
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Target hematocrit for Epoetin therapy Assessing iron stores for anemia patients prescribed Epoetin Maintaining target iron stores
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Administration of supplemental iron
Prioritizing the K-DOQI Guidelines
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To facilitate prioritizing the 114 K-DOQI Guidelines, over 200 stakeholders in the renal community were queried (via questionnaire) regarding the suitability of each guideline for CPMs.
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Responses were reviewed by the expert workgroups.
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36 of the 114 K-DOQI Guidelines were identified as appropriate candidates for conversion to clinical performance measures.
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The 4 workgroups convened to develop specific review criteria, algorithms & clinical performance measures for guidelines selected through the prioritization process.
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