Table 3.
PCMH-KD intervention outcome measures
| Measure | Instrument |
|---|---|
| Patient-Reported Outcomes | |
| Primary care coordination | Primary Care Assessment Survey |
| Quality of life | Kidney Disease Quality of Life-36 (KDQOL-36) |
| Management of chronic disease | Self-Efficacy for Managing Chronic Disease |
| Knowledge of hemodialysis | Chronic Hemodialysis Knowledge Survey |
| Depression Screening | Patient Health Questionnaire-9 |
| Medication compliance | Morisky Medication Adherence |
| Patient satisfaction with dialysis care | Consumer Assessment of Healthcare Providers and System: In-center Hemodialysis Survey |
| Fluid and dietary compliance | Renal Adherence Attitudes Questionnaire |
| Renal Adherence Behavior Questionnaire | |
| Comorbidities | Patient intake form |
| Dialysis history | Patient intake form |
| Clinical Outcomes | |
| Primary disease prevention | Receipt of age-appropriate cancer screenings |
| Receipt of recommended vaccinations | |
| Bone densitometry | |
| Periodontal disease | |
| Secondary disease prevention | Hemoglobin A1c measurement |
| Receipt of aspirin and/or beta-blockers | |
| Permanent vascular access | Type of access: fistula, graft, or catheter |
| Dialysis adequacy | Kt/V |
| Interdialytic weight gain (kg) | |
| Pre-and post-dialysis weight (kg) | |
| Urea reduction ratio | |
| Nutrition status | Serum albumin |
| Anemia management | Serum hemoglobin |
| Serum ferritin | |
| Serum transferrin saturation | |
| Bone and mineral metabolism and electrolytes | Serum parathyroid hormone (PTH) |
| Serum phosphorus | |
| Serum calcium | |
| Serum potassium | |
| Other | Pre- and post-dialysis systolic and diastolic blood pressure |
| Blood stream infections | |
| Treatment compliance: missed dialysis treatments or failure to complete entire dialysis treatment | |
| Current medications | |
| Status on transplant list (yes/no) | |
| Health Care Use | |
| Health care utilization | Number of inpatient hospital admissions |
| Number of readmissions to hospital within 30 days of discharge | |
| Number of avoidable hospitalizations | |
| Number of emergency room visits | |
| Staff Perceptions | |
| Dialysis Team Cohesiveness | Healthcare Team Vitality Instrument |