Lessons from implementation of a nephrology key performance indicator programme

We review the impact of a nephrology key performance indicator (KPI) program implemented over a ten-year period in Victoria, Australia. The program enabled transparent comparison of performance across nephrology units, however improvement against performance targets was not consistent and better understanding of KPIs is required to promote quality improvement.

We aimed to review the impact of the Victorian nephrology KPI programme over a 10-year period.

The KPI programme involved six KPIs related to the continuum of care for kidney replacement therapy: pre-dialysis education, vascular access at first haemodialysis, home dialysis rates, peritonitis rates, pre-emptive kidney transplantation and rates of transplantation/waitlisting. Data were collected monthly from the 10 Victorian nephrology services using a purpose-designed website portal. Results were analysed and reported every 3 months. We present a summary of each KPI and discuss changes over the 10-year period.

KPI data demonstrated significant differences in performance across KPIs after implementation, particularly in rates of home dialysis and transplant waitlisting. Changes within units were sometimes significant, but across Victoria, performance was relatively static. Over 10 years, there was a lack of significant improvement in clinical performance in several indicators and multiple changes to KPI targets were made.

The KPI programme enabled comparison of performance across nephrology units, but improvement in performance targets was not consistent over the 10-year period and the programme served as a means for benchmarking perhaps, rather than a quality improvement tool. Better understanding of each KPI and resources available for quality improvement is crucial for the success of a KPI programme.