Ability to Work among Patients with ESKD: Relevance of Quality Care Metrics

Nancy Kutner,Rebecca Zhang

doi:10.3390/healthcare5030042

Abstract

Enabling patient ability to work was a key rationale for enacting the United States (US) Medicare program that provides financial entitlement to renal replacement therapy for persons with end-stage kidney disease (ESKD). However, fewer than half of working-age individuals in the US report the ability to work after starting maintenance hemodialysis (HD). Quality improvement is a well-established objective in oversight of the dialysis program, but a more patient-centered quality assessment approach is increasingly advocated. The ESKD Quality Incentive Program (QIP) initiated in 2012 emphasizes clinical performance indicators, but a newly-added measure requires the monitoring of patient depression—an issue that is important for work ability and employment. We investigated depression scores and four dialysis-specific QIP measures in relation to work ability reported by a multi-clinic cohort of 528 working-age maintenance HD patients. The prevalence of elevated depression scores was substantially higher among patients who said they were not able to work, while only one of the four dialysis-specific clinical measures differed for patients able/not able to work. Ability to work may be among patients’ top priorities. As the parameters of quality assessment continue to evolve, increased attention to patient priorities might facilitate work ability and employment outcomes.

Highlights

In a recent international study, patients with end-stage kidney disease (ESKD) who were receiving hemodialysis (HD) named ability to work as one of their top ten priority outcomes [1]
In data obtained for a large prevalent HD cohort, we examined ability to work reported by working-age patients in relation to five current Quality Incentive Program (QIP) metrics (Table 1); i.e., indicators of Kt/V dialysis adequacy, anemia management, current vascular access type, mineral metabolism, and depression
The proportion who attained hemoglobin and serum phosphorus targets did not differ for patients who reported being able to work, smaller proportions attained these outcomes than was true for the dialysis adequacy target, which may reflect lower consensus about clinical management of these two areas

Summary

Introduction

In a recent international study, patients with end-stage kidney disease (ESKD) who were receiving hemodialysis (HD) named ability to work as one of their top ten priority outcomes [1]. Employment is a life area that may be dramatically disrupted for individuals with kidney disease who require ongoing renal replacement therapy (RRT), especially those who receive maintenance dialysis. Most working-age persons with ESKD who initiate maintenance dialysis treatment were employed before the start of treatment [2], but fewer than half of these persons report being “able” to work after RRT is initiated [3,4,5]. We examined five currently monitored quality measures in relation to ability to work reported by a large US cohort of working-age individuals who were receiving clinic-based maintenance HD. We hypothesized that the proportion of patients meeting each quality of Healthcare 2017, 5, 42; doi:10.3390/healthcare5030042 www.mdpi.com/journal/healthcare

Methods

Results

Discussion

Conclusion