Increase the proportion of people on Medicare who get follow-up care 3 months after kidney injury — CKD‑03 Data Methodology and Measurement

About the National Data

Data

Baseline: 10.3 percent of Medicare beneficiaries aged 65 years and over who incurred acute kidney injury had a follow-up evaluation of their kidney function within 3 months post discharge in 2016

Target: 16.4 percent

Numerator
Number of Medicare beneficiaries aged 65 years and over with an acute kidney injury hospitalization who had a urine albumin test within 3 months post discharge.
Denominator
Number of Medicare beneficiaries aged 65 years and over with an acute kidney injury hospitalization in the Medicare 5 percent sample.
Target-setting method

Projection

Target-setting method details
Linear trend fitted using weighted least squares and a projection at the 50 percent prediction interval.
1
Target-setting method justification
Trend data were evaluated for this objective. Using historical data points, a trend line was fitted using weighted least squares and the trend was projected into the next decade. This method was used because three or more comparable data points were available, the projected value was within the range of possible values, and a projection at the 50 percent prediction interval was selected because no additional information could be used to assess the trend line so the target was based on the projection (50 percent).

Methodology

Methodology notes

The data are analyzed for Medicare patients aged 65 or older (5 percent of Medicare sample) with a hospitalized acute kidney injury event in given year. Hospitalized acute kidney injury is defined by the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code N17 in inpatient claims.

Kidney function is evaluated based on the urine albumin test. Patients are followed from the discharge date to the earliest of the following dates: (1) death, (2) ESKD, (3) end of Medicare coverage, or (4) three months after the discharge date. Current Procedural Terminology (CPT) codes for urinary albumin measurement are identified from Healthcare Effectiveness Data and Information Set (HEDIS) 2018 specifications and include 82042, 82043, 82044, and 84156. (HEDIS 2018, a program of the National Committee for Quality Assurance, is used to monitor the performance of managed health care plans.)

USRDS data, data collection procedures, calculation methods, and other technical information are included in the USRDS Annual Data Report.

History

Comparable HP2020 objective
Modified, which includes core objectives that are continuing from Healthy People 2020 but underwent a change in measurement.
Changes between HP2020 and HP2030
This objective differs from Healthy People 2020 objective CKD-3 in that objective CKD-3 tracked persons who had a follow-up evaluation within 6 months of hospitalization, while this objective tracks those who had a follow-up evaluation within 3 months of hospitalization.
Revision History
Revised. 

In 2021, the original baseline was revised from 10.5 to 10.3 percent due to USRDS rates re-estimation. There is some lag in reporting new cases of ESRD. Therefore, each year’s Annual Data Report includes re-estimates of earlier year rates. For more information see the USRDS Annual Data Reports. The target was adjusted from 16.6 to 16.4 percent to reflect the revised baseline using the original target-setting method.


1. Because Healthy People 2030 objectives have a desired direction (e.g., increase or decrease), the confidence level of a one-sided prediction interval can be used as an indication of how likely a target will be to achieve based on the historical data and fitted trend.