Prepared by Dr.

Matteo Savoia

Introduction
Training
Medical KPIs in Hemodialysis
NephroCare Balance Score Card
& Medical Patient Review

Co-authors:
Dr. Vratislava Kovarova
Dr. Otto Arkossy
© Copyright 2020 Fresenius Medical Care Deutschland GmbH
Medical KPIs in Hemodialysis and Medical Patient Review

Disclaimer

Legal disclaimer for medical educational material

This learning course is for informational purposes only. It is intended to assist healthcare professionals in
forming their own conclusion and making decisions. It is not medical advice and not intended to replace
the judgement or experience of the attending physician or other healthcare professional. The treatment
of patients as well as treatment prescriptions are the sole responsibility of the attending physician or
healthcare provider.

Medical science is subject to constant change. The continuous expansion of our knowledge through new
research results and clinical experience requires constant changes and reassessments of the therapies
used. The therapies described in this learning course are partly not yet established standards and
subject of intensive research. To ensure that the information provided is up to date and corresponds with
the knowledge at the time of publication, the authors have therefore used sources that can be classified
as reliable: Medical Guidelines, reviews and selected clinical studies. Despite the greatest possible care,
it cannot be guaranteed that the information contained therein is free of errors. Therefore, no liability can
be accepted for any consequences resulting from the use of this information. Readers are cautioned not
to rely solely on the information contained in this learning course but to gain a comprehensive overview
of the current scientific information themselves.
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

NC BSC & MPR - EMEA Network

Currently, in the Region of EMEA 24 Countries and 653 active clinics are using the clinical database EuCliD
and can have access to the Medical Patient Review Reports (status as of Q3 2021)
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

The NephroCare Balance Score Card

What is the NephroCare Balance Score Card (NC BSC)?

• Balanced Scorecard (BSC) is a management tool that allows the

consideration of a very large number of variables by translating
these into a few performance measures. These measures are a
combination of operational and medical indicators which reflect
internal processes and continuous improvement of the organization.
Balancing
conflicting
What do we want to achieve with NephroCare Balance Score
stakeholder
interests Card (NC BSC)?

• NC BSC as a tool serving country management to manage their

NC BSC local NC organizations targeting on common objectives and Key
purpose: Align Performance Indicators quantifying measure of performance
NephroCare over time
network
Focus Drive • NC BSC provides a cockpit to follow-up achievement of clinical
attention on continuous and operational targets on country and clinic level
priorities improvement
• NC BSC as focus point for detailed review of clinical and
operational results
• Applying the NC BSC ensures a well-balanced approach of all four
stakeholder interests
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

The NephroCare Balance Score Card
The basic idea of the NC BSC is to organize all performance measures along four different perspectives and to select
performance measures and targets that correlate with the strategic objectives of the organization.

The patient perspective focuses on the increase of life expectancy and the improvement of
the quality of life of patients treated within the NephroCare network. The selected performance
measures (Key Performance Indicators, KPIs) describe how well the dialysis process has been
performed and report clinical status of the patient. Patients

The employee perspective bind qualified personnel and promote their professional development.
Therefore, the corresponding performance measures focus on human resource management.
Employees

The shareholder perspective has as object the continuous development of the company and
attractive returns for its shareholders; performance measures relate to well-established management
processes and financial controls.
Shareholders

The community perspective are the upholding of various social responsibilities, the following of all
legal and regulatory requirements and safety standards, and the contribution to the maintenance of
the environment.
Community

The corresponding performance measures are heterogeneous, including performance indicators for the minimization of accidents
to employees, for achievement of ISO certification, and for the reduction of water, electricity and waste.
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis: Medical Perspective

• Considered for evaluation are only the so

called BSC Active patients: being active within
FME since 3 months at least (pre-dialysis
status will not be taken into consideration)
and which are not out of the centre for more
than 14 days within the month of evaluation
(e.g. for hospitalisation or vacation), nor in the
incremental dialysis treatment, nor HD under 16
years of age.
• The medical KPIs are expressed as percentage
of patients in target for the month of analysis.
A patient is defined in target according to the
business logic of the KPIs logic (reported on
next slide).
• Please also note that treatment data needs to
Screenshot from Balance Score Card DashBoard
be completed to be considered for evaluation.
Medical Increased reporting compliance in EuCliD will
also contribute to an improved scoring of your
patients.
Patients
• You may find different measuring units in EuCliD
and the BSC. For harmonization purposes of all
• Negotiated Target Represent the performance goal that each data sources internationally used and commonly
Country/Clinic should achieve over the ongoing year. applied conversion factors are integrated.
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

Medical Perspective - Description of KPI´s targets
Objective KPI Description
Effective Weekly Effective treatment time per week is at least 720 minutes for patients with age <85 within current month (and 660 minutes for patients with
Treatment Time age ≥85).
Infusion or If at least 75% of treatments per month were done with O-HDF post-diluition then Infusion Blood Volume per week of at least 63 liters is
Blood Volume required (58 liters for elderly patients). Otherwise Blood Volume per week is at least 240 liters (220 liters for elderly patients).

Improve dialysis Single pool Kt/V is at least 1.4 with at least 2 treatments per week (or lower when more than 4 treatments per week) based either on
Single Pool Kt/V
process average of CM spkt/V or on average lab test spkt/V within last month.

Vascular Access Native Fistula or graf used as vascular access for all treatments during the month.

Hepatitis B At least 3 HBV Vaccinations were done for eligible patients within first 9 month or at any other time before admission for HbsAg negative
vaccination and HbsAb <10 IU/l patients.

Albumin Last lab value for Serum albumin within last 3 months is at least 3,5 g/dL with green or purple test.

Haemoglobin Last lab value for haemoglobin of last month is at least 10 g/dL (if no EPO was submitted) or ≥10 and ≤12 g/dL (if EPO was submitted).

Hydration Status Average relative overhydration from the last BCM measurement within last 13 weeks is at maximum 13% for females and 15% for males.

If in one of the last two consecutive months the Patient is in the following conditions: Pre-HD sys BP ≥130 and <160 mmHg without
Hameodynamic antihypertensive therapy.
Improve Dialysis Status Pre-HD sys BP <130 mmHg without antihypertensive therapy with normal hydration Status.
Outcomes Pre-HD sys BP ≥130 and <160 mmHg with antihypertensive therapy but with normal hydration Status.

Last lab value for phosphate of last 2 months is below mg/dl. (if no phosphate binder was submitted) or ≥2.5 and <5.5 mg/dL (if
Phosphate
phosphate binder was submitted).
Last lab value for Calcium Corrected of last 3 months is ≥8,4 and ≤10,2 mg/dL or <8,4 mg/dL (after Parathyroidectomy or iPTH Corrected
Calcium
<130 pg/ml and on Vit D oral).

Last lab value for iPTH corrected of last 6 months is ≥130 and ≤585 pg/ml or ≥130 pq/ml for patients after Parathyroidectomy or <130
iPTH pq/ml and without Calcium mimetics or without Vit D IV or <130 pg/ml and calcium corrected ≥8,4 and ≤10,2 mg/dL or <130 pg/ml and
calcium corrected «<8,4 mg/dL and on Vit D oral.

Support Kidney Patients on transplant % of HD and PD patients on kidney transplant waiting list from all patients (excluding not eligible patients, patients <12 months at FME,
Transplantation waiting list patients in the incremental dialysis and HD patients under 16 years of age) at end of the selected month.
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

Medical Perspective - MPR Introduction

The Medical Patients Review (MPR) is a fast, illustrated and easy-to-generate reporting tool developed to support
the Country Medical Directors (CMDs) and NephroCare staff in the regular monitoring of clinical activities, using data
collected in EuCliD.

It supports the medical staff to understand for each patient the target achievement for the medical KPIs of the NC BSC
and provides complementary information in order to assess all parameters of the individual patient.

It represents one of the pillars of our Continuous Quality Improvement (CQI) cycles applied in all clinics of the network
aiming at evidence-based goals established by the company in respect of the medical guidelines, to guarantee the
delivery of appropriate care and increase the quality of life for each patient.

The reports can easily be generated from EuCliD. They are formatted to facilitate the detection of deviations from
predefined targets, hereby allowing the immediate application of corrective actions. Over time, the impact of these
corrective actions can be followed.

This common system of reporting allows to benchmark patient outcomes and clinical performance across dialysis units
and countries.
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis: MPR Reports in EuCliD

• The MPR Reports are downloadable from EuCliD in Excel compatible format.
• The catalogue includes reports on many different topics.
• Each month, the Clinical & Therapeutical Governance EMEA valuate and discuss medical performances of countries and
dialysis centers with the Country Medical Directors on the base of the results included into EuCliD MPR reports.

COUNTRY MEDICAL PATIENT REVIEW CLINIC MEDICAL PATIENT REVIEW

(reports visible only for the profile: Country visible also for the profiles: Medical, Head Nurse,
Key Person) Nurse, Pharmacist, Nutritionist

• Country Anemia Management • MPR - All Variables Clinic Research

• Country Clinic Score • MPR - Anemia Management
• Country Clinic Scores Extended • MPR - Blood Pressure Status Management - BSC hemodynamic status
• Country Hemodynamic Status • MPR - Calcium-Phosphate Metabolism Management
• Country P-Binders • MPR - Clinic Score
• Country Vitamin D • MPR - Dialysis Adequacy Management
• MPR - All Variables Clinic Research • MPR - Electrolytes Status Management
• MPR - Infective Status • MPR - Infective Status
• MPR - TIR • MPR - Nutritional Status Management
• MPR Kidney Transplantation Monitoring • MPR - Patients Characteristics & Outcomes
• MPR-TVR Country Variance Report Summary Standard • Unit Specific Report Lab-Tests and Drugs
• MPR-TVR Month Country Patient Level Graphic • Unit Specific Report Patients
• MPR-TVR Clinic Summary Standard Graphics
• MPR-TVR Clinic Variance Report Standard
• MPR-TVR Clinic Variance Report Summary Standard
• MPR-TVR Month Clinic Patient Level Graphic
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis: MPR Reports - Download

1. On the EuCliD “Home Page”

click on Dialysis Unit Tab and a
Selection menu will open below

2. Select the section Report

to be re-directed to the
Reporting dedicated page
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis: MPR Reports - Download

Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

MPR Reports - The Clinic Score
Vascular Access
• Among Other, the so-called Clinic Scores gives
Weekly Treatment Time
an overview about the treatment performances Adequacy
at country, clinic and patient level according to Blood Volume processed/ infusion Total

the EuCliD user profile. OCM Kt/V

Systolic Blood Pressure Pre
• Clinic performances are evaluated looking at the Cardio OH/ECW Pre-HD
definition of the twelve medical KPIs included in Vascular
Disease Hemodynamic Status
the NC BSC (in white).
Fluid Removal
• The extended version of this report takes into Haemoglobin
consideration other 12 additional KPIs (in green). Erythropoietin resistance index (ERI)
Anemia
• Each report encloses the explanation of the Ferritin
business each single KPI. C-Reactive Protein
Phosphate
• Patients defined as “not in Target” for the KPIs Chronic Kidney
contribute to the calculation of the so called Disease – Mineral Calcium Corrected
Bone Disease
Active Problems. iPTH Corrected
Albumin

Nutritional & Lean Tissue Index

Diabetes Protein Catabolic Rate (n)
Diabetic HBA1C
Potassium (K)
Electrolytes Sodium (Na)
Bicarbonate (HCO3-)
Active on Transplantation List
Mission
Hepatitis B vaccination
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

MPR Reports - The Clinic Score in detail

NC BSC KPIs

Patient data
White:
BSC Active In red patients defined not in target according
Patients the business logic of the NC BSC KPIs

Clinic results are resumed on the page bottom as percentage of BSC active patients in target for each KPI

BSC Active Problems: numbers of KPIs not in target (red cells) for the NC BSC KPIs on 100 patients

Scoring System: Clinics are divided in tiers based on the number of Active Problems and defined by a
color code

A lower number of Active Problems indicates more patients in target and Better Performances
Medical KPIs in Hemodialysis and Medical Patient Review

Medical Key Performance Indicators in Hemodialysis:

MPR Reports - The Clinic Score Extended
NC BSC KPIs in Orange

White:
BSC Active
Patients

A lower number of Active Problems indicates more patients in target and Better Performances

Active Problems Extended: numbers of KPIs not in target (red cells) for the extended set of KPIs
(NC BSC + Others) on 100 patients

Dual Scoring System: Clinics are divided in tiers based on the number of Active Problems Extended and defined by a color
code. On this report a second score display the active problem adjusted on patients characteristics, defined by the age
adjusted Charlton comorbity index (aaCCI)
Medical KPIs in Hemodialysis and Medical Patient Review

Conclusions

• MPR represents the common language utilized across the

NephroCare clinic network.
• It allows benchmarking and monitoring of clinic performances.
• It facilitates the detection of deviations from predefined targets,
allowing the immediate application of corrective actions. Over time,
the impact of these corrective actions can be followed.
• The reports can be downloaded directly from EuCliD and consulted
at all times by each physician in the network.
• For any questions on how to make use on the MPR for your daily
work, please reach out to the Clinical & Therapeutical Governance
team at headquarters.

© Copyright 2020 Fresenius Medical Care Deutschland GmbH

 © Copyright 2020 Fresenius Medical Care Deutschland GmbH
Version 1.0
Head office : Fresenius Medical Care Deutschland GmbH, Else-Kröner-Straße 1, 61352 Bad Homburg, Germany
Phone : +49 (0) 6172-609-0 · Fax : +49 (0) 6172-609-2191