NDT Perspectives Measuring the quality of renal care: things to keep in mind when

This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surro-gate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some point-ers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indi-cator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain— i.e. subsequent aspects of care connected by evidence-based links—as a starting point for composing a performance indi-cator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facil-ities over time.Keywords: nephrology, quality indicators, quality of health car