Patient Management Assessment update



The Assessment Tool: Patient Management is intended to give you a quick view of your current practices related to management of patients with advanced Chronic Kidney Disease (CKD). It can be performed by your office nurse or assistant with the help of the “Helpful Hints for Chart Abstractors” provided at the end of this section.

It is possible that you may not be aware of the issues related to advanced CKD patient management. A quick internal review of 10 patient charts using this tool could reveal the extent of the problem.

Pointers for effective use of this tool:

• Once a patient has been identified as being in CKD stages 4/5, you can flag the exterior of the patient’s medical records chart with a CKD Chart Flag/Sticker (see toolkit, p. 79); flagged records can then be randomly selected for this assessment.

• The instructions for performing this assessment are on the following page. You can enter the data on the paper forms provided or, if you prefer, you may use the Excel spreadsheet (on the enclosed CD-ROM) for both data entry and analysis.

• The results (“rates”) that you calculate after completing the worksheet will provide you with an estimate of the extent to which advanced CKD patients in your practice are appropriately managed.

• Results from this assessment, when compared to those from the Evaluation Tool, will provide a measure of your performance-improvement efforts.

• Note that this tool is intended to be brief and focuses on management issues that are important and most practical to measure. If you would like to perform a more extensive audit, we direct you to the full set of clinical performance measures from the Clinical Performance Measures (CPM) table on page 75 in the Renal Physicians Association (RPA) Guideline #3 ().

• It is possible to customize this tool. For example, lab values/ranges can be altered. Values provided on the “master” represent those identified as best practices by the RPA Guideline working group.

Instructions

1. Select 10 patients in your practice who:

• you have followed for at least 6 months, and

• have had a GFR ≤30 mL/min or serum creatinine ≥2 mg/dL for at least 6 months (patients with serum creatinine ≥2 mg/dL are likely to have GFR ≤30 mL/min)

1. Obtain from the charts( of these 10 patients the most recent data regarding:

• Hemoglobin

• Serum phosphorus

• Blood pressure

• Documented discussion of dialysis modalities and kidney transplant (yes or no)

2. Record data obtained for each identified patient on the Analysis Sheet (toolkit, p. 19).

3. Sum each column and calculate the rates (sum of column x 10).

PATIENT MANAGEMENT ANALYSIS SHEET

*

|Pre-Implementation Assessment Tool: Patient Management Analysis Sheet |

|Patient # |Is the GFR ≤ 30|Most recent value of hemoglobin measurement within the |Most recent of serum phosphorous within the past 6 |Most recent blood pressure reading |Documented |

| |mL/min or serum|past 6 months |months | |discussion about |

| |creatinine ≥ 2 | | | |dialysis modalities|

| |mg/mL? For | | | |and transplant? |

| |confirmation | | | | |

| |only | | | | |

| |≥ 12 gm/dL |11-11.9 gm/dL |≤ 10.9 gm/dL |No value * |≤ 4.5 mg/dL |4.6-5.5 mg/dL |>5.5 mg/dL |No value * |≤ 130 systolic And ≤ 80 diastolic |131-150 systolic OR 81-90 diastolic |≥ 151 systolic OR ≥ 91 diastolic |No value* | | |1. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |2. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |3. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |4. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |5. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |6. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |7. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |8. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |9. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |10. |  |  |  |  |  |  |  |  |  |  |  |  |  |  | |Sum of column |No Value Required |  |  |  |  |  |  |  |  |  |  |  |  |  | |Rate (%) = Sum of Column x 10 |0 |0 |0 |0 |0 |0 |0 |0 |0 |0 |0 |0 |0 |0 | |

Helpful Hints For Chart Abstractors

Using RPA Evaluation Tools

• Creatinine—Serum creatinine values can be obtained from lab reports. Take care not to confuse urine and serum creatinine reports.

• GFR—Glomerular filtration rate is an estimate of kidney function. The value can be provided by the laboratory on the lab report, or calculated by the provider using a mathematical equation (MDRD) or a paper slide rule or computer (see GFR Calculator, p. 74). Units are typically expressed as mL/min/1.73m2 or abbreviated as mL/min.

• Hb—Abbreviation for hemoglobin.

• Hct—Abbreviation for hematocrit.

• Hemoglobin/Hematocrit conversion factor—If a Hct reading is found and a Hb measurement is not, estimate the Hb by dividing Hct by 3.

• Multiple Values—If multiple values are found for GFR, blood test results, or blood pressure readings, use the most recent value available. Results should be within the past 6 months.

• No Value—Parameter not measured within the past 6 months.

• RRT—Abbreviation for renal replacement therapy (hemodialysis, peritoneal dialysis or kidney transplant).

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If Hematocrit (Hct) is monitored instead of hemoglobin (Hb), estimate Hb by dividing Hct by 3.

* No Value = parameter not measured within the past 6 months.

Please note: Definitions of the terms in this handout pertain to the context in which they are used for these evaluation tools. Please consult with your physician prior to using the evaluation tools or these definitions.

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