From Concept to Implementation: Developing a Quality Measure for Chronic Kidney Disease Patients with Hypertension

Hypertension, or high blood pressure, is the second leading cause of chronic kidney disease (CKD), damaging kidney blood vessels, overworking the kidneys, and putting extra stress on the heart that disrupts proper blood flow ⁱ. National surveillance data indicates that CKD prevalence among adults with hypertension was 24.6% in 2017–2020, and 75.3% of people with CKD had hypertension ⁱⁱ. Due to the chronic disease intersection, rising hypertension rates present a challenge to effectively preventing and controlling CKD within the population.

Given the strong association to kidney disease progression, the American College of Cardiology/American Heart Association; International Society of Hypertension; and Kidney Disease: Improving Global Outcomes (KDIGO) ^{iii, iv}, recommend that individuals with hypertension should be routinely screened for CKD, particularly to assess for evidence of albuminuria or kidney damage. However, only 10-15% of people with hypertension are tested annually for albuminuria ^v.

To address gaps in CKD detection and increase screening prioritization across primary care, the National Kidney Foundation (NKF) engaged a technical expert panel of 10 national healthcare leaders on the development of a quality measure for kidney health evaluation in patients with hypertension. These key informants reviewed the clinical guidelines and provided data-driven recommendations to develop the initial parameters for a claims-based measure design. 

To inform measure development, NKF partnered with the Midwest Health Initiative (MHI) to apply the measure specifications to a commercial claims dataset. MHI is a St. Louis-based multistakeholder collaborative that stewards Missouri’s only commercial claims data warehouse. With over 1.7 million commercial lives represented in the data, MHI conducts and supports robust projects focused on healthcare value provided to commercial patients across the state. MHI’s role in this quality measure development included attending the expert panel sessions to answer questions about MHI’s dataset, present data to inform panel discussions about inclusion criteria, test the measure specifications through data analysis, and communicate the measure within the St. Louis healthcare community. 

Following MHI’s analysis, the technical specifications were refined for the proposed measure and additionally evaluated within a local health system’s electronic health record for validation across the high-risk patient population. The measure design was then finalized with consensus from the panel, and later that year, MHI added it to their 2024 St. Louis Health Stats and 2024 Kansas City Health Stats community scorecards for public reporting on testing fulfillment in the commercially insured population. As noted, only 18.5% of commercial patients with hypertension in the St. Louis MSA and 20% of patients with hypertension in the Kansas City MSA received the recommended kidney screening. MHI’s community scorecards are continuously used by large local employers to benchmark the health of their own plan members and serve as a vehicle for increasing awareness of key screening areas.

NKF is in ongoing conversations with the National Committee for Quality Assurance regarding opportunities for expansion of the current Kidney Health Evaluation for Patients with Diabetes (KED) measure to include patients with hypertension. This measure design will create the foundation for prospective development of a composite measure focused on comprehensively addressing cardio-kidney-metabolic health across ambulatory care. 

For more information on this initiative or to pilot the measure design within your own data and understand CKD quality improvement opportunities, please reach out to NKF’s population health team at population.health@kidney.org.