Quality indicators are measurements of healthcare outcome, process, or structure that can be used as tools to measure the quality of care and identify opportunities for improvement. Acute kidney injury (AKI) has many characteristics that make it a potential target for quality indicator development. It is common, associated with a high risk of adverse outcomes, and there are reports of gaps in the quality of care in several clinical settings despite publication of evidence-based guidelines. Substantial work has already been undertaken to develop quality measures related to AKI following percutaneous coronary interventions and major surgical procedures. This paper reviews the current literature that has addressed issues of prevention or management of AKI as outcome, process, or structure quality indicators in these clinical settings. Several current controversies about the appropriateness of such indicators related to AKI are identified. Further research to strengthen the evidence-base supporting prevention and management initiatives for AKI across all relevant clinical settings is needed to clarify the role of AKI as a target for clinical quality indicators.

Keywords:
Acute kidney injury, Performance measurement, Clinical quality improvement
1.
Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C: Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One 2011;6:e20476.
2.
Normand SL, McNeil BJ, Peterson LE, et al: Eliciting expert opinion using the Delphi technique: identifying performance indicators for cardiovascular disease. Int J Qual Health Care 1998;10:247-260.
3.
Kidney Disease: Improving Global Outcomes (KDIGO). Clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1-138.
4.
National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Adding Insult to Injury. London, NCEPOD, 2009.
5.
Ko DT, Wijeysundera HC, Zhu X, Richards J, Tu JV; National Expert Panel: Canadian quality indicators for percutaneous coronary interventions. Can J Cardiol 2008;24:899-903.
6.
Czarnecki A, Prasad TJ, Wang J, Wijeysundera HC, Cheema AN, DŽavík V, Natarajan MK, Simpson CS, So DY, Syed J, Tu JV, Ko DT: Adherence to process of care quality indicators after percutaneous coronary intervention in Ontario, Canada: a retrospective observational cohort study. Open Heart 2015;2:e000200.
7.
Nallamothu BK, Tommaso CL, Anderson HV, Anderson JL, Cleveland JC Jr, Dudley RA, Duffy PL, Faxon DP, Gurm HS, Hamilton LA, Jensen NC, Josephson RA, Malenka DJ, Maniu CV, McCabe KW, Mortimer JD, Patel MR, Persell SD, Rumsfeld JS, Shunk KA, Smith SC Jr, Stanko SJ, Watts B: ACC/AHA/SCAI/AMA-convened PCPI/NCQA 2013 performance measures for adults undergoing percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures, the Society for Cardiovascular Angiography and Interventions, the American Medical Association-Convened Physician Consortium for Performance Improvement, and the National Committee for Quality Assurance. J Am Coll Cardiol 2014;63:722-745.
8.
Zeng X, McMahon GM, Brunelli SM, Bates DW, Waikar SS: Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014;9:12-20.
9.
Sileanu FE, Murugan R, Lucko N, Clermont G, Kane-Gill SL, Handler SM, Kellum JA: AKI in low-risk versus high-risk patients in intensive care. Clin J Am Soc Nephrol 2015;10:187-196.
10.
Lin J, Fernandez H, Shashaty MG, Negoianu D, Testani JM, Berns JS, Parikh CR, Wilson FP: False-positive rate of AKI using consensus creatinine-based criteria. Clin J Am Soc Nephrol 2015;10:1723-1731.
11.
Amin A, Salisbury A, McCullough PA, Gosch K, Spertus JA, Venkitachalam L, Stolker JM, Parikh CR, Masoudi FA, Jones PG, Kosiborod M: Trends in the incidence of acute kidney injury in patients hospitalized with acute myocardial infarction. Arch Intern Med 2012;172:246-253.
12.
Brown JR, Solomon RJ, Sarnak MJ, McCullough PA, Splaine ME, Davies L, Ross CS, Dauerman HL, Stender JL, Conley SM, Robb JF, Chaisson K, Boss R, Lambert P, Goldberg DJ, Lucier D, Fedele FA, Kellett MA, Horton S, Phillips WJ, Downs C, Wiseman A, MacKenzie TA, Malenka DJ; Northern New England Cardiovascular Disease Study Group: Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention. Circ Cardiovasc Qual Outcomes 2014;7:693-700.
14.
Zrelak PA, Romano PS, Tancredi DJ, Geppert JJ, Utter GH: Validity of the AHRQ patient safety indicator for postoperative physiologic and metabolic derangement based on a national sample of medical records. Med Care 2013;51:806-811.
16.
James MT, Pannu N, Barry R, Karsanji D, Tonelli M, Hemmelgarn BR, Manns BJ, Bagshaw SM, Stelfox HT, Dixon E: A modified Delphi process to identify process of care indicators for the identification, prevention and management of acute kidney injury after major surgery. Can J Kidney Health Dis 2015;2:11.
© 2015 S. Karger AG, Basel
2015
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