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## Complete Summary

#### TITLE

Chronic kidney disease (CKD): percentage of visits for patients aged 18
years and older with the diagnosis of advanced CKD (stage 4 or 5, not
receiving RRT), with a blood pressure less than 130/80 mmHg OR blood
pressure greater than or equal to 130/80 mmHg with a documented plan of
care.

#### SOURCE(S)

Renal Physicians Association, Physician Consortium for Performance
Improvement®. Chronic kidney disease physician performance measurement
set. Chicago (IL): American Medical Association; 2007 Oct. 32 p. \[13
references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of visits for patients
aged 18 years and older with the diagnosis of advanced chronic kidney
disease (CKD) (stage 4 or 5, not receiving renal replacement therapy
\[RRT\]), with a blood pressure less than 130/80 mmHg OR blood pressure
greater than or equal to 130/80 mmHg with a documented plan of care.

#### RATIONALE

Identification of hypertension in patients with chronic kidney disease
(CKD) is an essential part of management of the disease. Hypertension is
common in patients with CKD, and if hypertension is left untreated, it
will speed the progression of the disease. Recent research has shown
that during office visits, approximately 20% to 30% of CKD patients do
not have their blood pressure measured. Additionally, if the CKD patient
has an anemia/erythropoiesis-stimulating agents (ESA) visit; they are
even less likely to have their blood pressure measured. In these
patients, recent research has shown that 75% do not have their blood
pressure measured at an anemia/ESA visit. Patients with CKD should have
their blood pressure measured at each office visit so that changes can
be identified and treatment initiated as soon as it is necessary. Blood
pressure control is important in slowing the progression of chronic
kidney disease. By slowing the progression of the disease, quality of
life is improved for the patient, and it results in a longer period of
time before a patient requires renal replacement therapy. Patients with
chronic kidney disease should have a lower target blood pressure (less
than 130/80) than other patients with hypertension.\*

\*The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines and
represent the evidence base for the measure:

Blood pressure should be measured at each health encounter. (National
Kidney Foundation \[NKF\], 2004)

If a patient has glomerular filtration rates (GFR) less than or equal to
30 ml/min/1.73m^2^, then his/her blood pressure should be checked with
every clinic visit. (Renal Physicians Association \[RPA\], 2002)

If a patient has a GFR less than or equal to 30 ml/min/1.73m^2^, and if
blood pressure is determined to be elevated (systolic greater than 130
mmHg OR diastolic greater than 80 mmHg), then s/he should receive
intensified antihypertensive therapy. (RPA, 2002)

Patients with CKD should be considered in the \"highest-risk\" group for
cardiovascular disease (CVD) for implementing recommendations for
pharmacological therapy, irrespective of cause of CKD. (NKF, 2004)

Target blood pressure for CVD risk reduction in CKD and
diabetic/nondiabetic kidney disease should be less than 130/80 mmHg.
(NKF, 2004)

#### PRIMARY CLINICAL COMPONENT

Chronic kidney disease (CKD); blood pressure; hypertension

#### DENOMINATOR DESCRIPTION

All visits for patients aged 18 years and older with the diagnosis of
advanced chronic kidney disease (CKD) (stage 4 or 5, not receiving renal
replacement therapy \[RRT\])

#### NUMERATOR DESCRIPTION

Patient visits with blood pressure less than 130/80 mmHg OR greater than
or equal to 130/80 mmHg with a documented plan of care (see the related
\"Numerator Inclusions/Exclusions\" field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [K/DOQI clinical practice guidelines on hypertension and
    antihypertensive agents in chronic kidney
    disease.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=6186)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Patwardhan MB, Matchar DB, Samsa GP, Haley WE. Utility of the advanced
chronic kidney disease patient management tools: case studies. Am J Med
Qual2008 Mar-Apr;23(2):105-14.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=18305098)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All visits for patients aged 18 years and older with the diagnosis of
advanced chronic kidney disease (CKD) (stage 4 or 5, not receiving renal
replacement therapy \[RRT\])

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All visits for patients aged 18 years and older with the diagnosis of
advanced chronic kidney disease (CKD) (stage 4 or 5, not receiving renal
replacement therapy \[RRT\])

**Exclusions**\
None

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patient visits with blood pressure less than 130/80 mmHg OR greater than
or equal to 130/80 mmHg with a documented plan of care\*

\*A documented plan of care should include one or more of the following:
recheck blood pressure at specified future date; initiate or alter
pharmacologic therapy; initiate or alter non-pharmacologic therapy;
documented review of patient\'s home blood pressure log which indicates
that patient\'s blood pressure is or is not well controlled.

If multiple blood pressure measurements are taken at a single visit, use
the most recent measurement taken at that visit.

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #1: blood pressure management.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1852&doc=178)

#### MEASURE SET NAME

[Chronic Kidney Disease Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1852&doc=12067)

#### SUBMITTER

American Medical Association on behalf of the Renal Physicians
Association and the Physician Consortium for Performance Improvement®

#### DEVELOPER

Physician Consortium for Performance Improvement®\
Renal Physicians Association

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

William Haley, MD (*Co-Chair*); Bonnie McCafferty, MD, MSPH
(*Co-Chair*); Todd Davis, MD; Barbara Fivush, MD; Richard S. Goldman,
MD; John Hartman, MD; Richard Hellman, MD, FACP, FACE; Edward Jones, MD;
Craig B. Langman, MD; Cathi Martin, RD; Charles McAllister, MD, MBA,
FCAP; Paul Rockswold, MD, MPH; Sam J.W. Romeo, MD, MBA; Anton C.
Schoolwerth, MD, FAHA; Lesley Stevens, MD; Joseph Vassalotti, MD;
Candace Walworth, MD; Don Wesson, MD; David Witte, MD, PhD, FCAP; Jerry
Yee, MD

Robert Blaser, Renal Physicians Association; Dale Singer, Renal
Physicians Association

Phil Renner, MBA, National Committee for Quality Assurance

Susan Nedza, MD, MBA, FACEP, Centers for Medicare & Medicaid Services;
Desurai Wilson, Centers for Medicare & Medicaid Services

Chris Izui, Health Plan Representative (BCBS)

Elvira Ryan, RN, The Joint Commission; Ann Watts, RN, The Joint
Commission

Kendra Hanley, MS, CHE, American Medical Association; Erin O. Kaleba,
MPH, American Medical Association; Karen S. Kmetik, PhD, American
Medical Association

Rebecca A. Kresowik, Facilitator; Timothy F. Kresowik, MD, Facilitator

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### INCLUDED IN

Ambulatory Care Quality Alliance\
Physician Quality Reporting Initiative

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Renal Physicians Association, Physician Consortium for Performance
Improvement®. Chronic kidney disease physician performance measurement
set. Chicago (IL): American Medical Association; 2007 Oct. 32 p. \[13
references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #1: Blood Pressure Management,\" is
published in the \"Chronic Kidney Disease Physician Performance
Measurement Set.\" This document and technical specifications are
available in Portable Document Format (PDF) from the American Medical
Association (AMA)-convened Physician Consortium for Performance
Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on March 27, 2008. The
information was verified by the measure developer on June 11, 2008.

#### COPYRIGHT STATEMENT

© 2007 American Medical Association. All Rights Reserved.

CPT® Copyright 2006 American Medical Association

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008