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Objectives and Subobjectives
Goal:
Reduce new cases
of chronic kidney disease and its complications, disability, death, and
economic costs.
As a result of the Healthy People 2010 Midcourse
Review, changes were made to the Healthy People 2010 objectives and
subobjectives.
These changes are
specific to the following situations:
-
Changes
in the wording of an objective to more accurately describe what is being
measured.
-
Changes
to reflect a different data source or new science.
-
Changes
resulting from the establishment of a baseline and a target (that is, when a
formerly developmental objective or subobjective became measurable).
-
Deletion
of an objective or subobjective that lacked a data source.
-
Correction of errors and omissions in Healthy People 2010.
Revised baselines and targets for measurable objectives and
subobjectives do not fall into any of the above categories and, thus, are not
considered a midcourse review change.1
When changes were made to an objective, three
sections are displayed:
-
In the
Original Objective section, the objective as published in Healthy People 2010 in
2000 is shown.
-
In the
Objective With Revisions section, strikethrough indicates text deleted, and
underlining is used to show new text.
-
In the Revised Objective section, the objective appears as revised
as a result of the midcourse review.
Details of the objectives and subobjectives in this focus area, including any changes made at the midcourse, appear on the following pages.
1See Technical Appendix for more information on baseline and target revisions.
NO
CHANGE IN OBJECTIVE
(Data updated and footnoted)
|
4-1. |
Reduce
the rate of new cases of end-stage renal disease (ESRD).
Target:
2211 new cases per million
population.
Baseline: 3002 new cases of end-stage
renal disease per million population were reported in 1997 (age adjusted to
2000 standard population).
Target
setting method:
Better
than the best.
Data
source:
U.S.
Renal Data System (USRDS), NIH,
NIDDK.
1 Target revised from 217 because of
baseline revision after November 2000 publication.
2 Baseline revised from 289 after
November 2000 publication.
|
NO
CHANGE IN OBJECTIVE
(Data updated and footnoted)
|
4-2. |
Reduce
deaths from cardiovascular disease in persons with chronic kidney failure.
Target:
62.11 deaths per 1,000 patient
years at risk.
Baseline:
86.42 deaths from
cardiovascular disease per 1,000 patient years at risk (in persons with ESRD)
occurred in 1997.
Target
setting method:
Better
than the best.
Data
source:
U.S. Renal Data
System (USRDS), NIH, NIDDK.
1 Target revised from 52 because of
baseline revision after November 2000 publication.
2 Baseline revised from 70 after November
2000 publication.
|
NO
CHANGE IN OBJECTIVE
|
4-3. |
Increase
the proportion of treated chronic kidney failure patients who have received
counseling on nutrition, treatment choices, and cardiovascular care 12 months before the start of renal replacement therapy.
Target:
60 percent.
Baseline:
45 percent of newly diagnosed patients
with treated chronic kidney failure received counseling on nutrition,
treatment choices, and cardiovascular care in 1996.
Target
setting method:
33 percent
improvement.
(Better than the best
will be used when data are available.)
Data
source:
U.S. Renal Data
System (USRDS), NIH, NIDDK.
|
NO
CHANGE IN OBJECTIVE
|
4-4. |
Increase
the proportion of new hemodialysis patients who use arteriovenous fistulas as
the primary mode of vascular access.
Target:
50 percent.
Baseline:
29 percent of newly diagnosed patients 20
years and older with treated chronic kidney failure on hemodialysis used
arteriovenous fistulas as the primary mode of vascular access in 1997.
Target
setting method:
72 percent
improvement (consistent with Dialysis Outcomes Quality Initiative [DOQI]
guidelines).
(Better than the best
will be used when data are available.)
Data
source:
Centers for
Medicare & Medicaid Services Clinical Performance Measures (CPM) Project,
CMS.
|
NO
CHANGE IN OBJECTIVE
(Data
updated and footnoted)
|
4-5. |
Increase
the proportion of dialysis patients registered on the waiting list for
transplantation.
Target:
30.01 percent of dialysis
patients.
Baseline:
21.92 percent of newly
diagnosed treated chronic kidney failure patients under age 70 years were
registered on the waiting list in 1998.2
Target
setting method:
Better
than the best.
Data
source:
U.S. Renal Data
System (USRDS), NIH, NIDDK.
1 Target revised from 66 because of
baseline revision after November 2000 publication.
2 Baseline and baseline year revised from
20 and 1994–96 after November 2000 publication.
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ORIGINAL
OBJECTIVE
|
4-6. |
Increase
the proportion of patients with treated chronic kidney failure who receive a
transplant within 3 years of registration on the waiting list.
Target: 51 registrants per 1,000 patient years at
risk.
Baseline: 41 registrants per
1,000 patient years at risk (since placed on dialysis) received a transplant
within 3 years in 1995–97.
Target
setting method: Better
than the best.
Data
source: U.S. Renal Data
System (USRDS), NIH, NIDDK.
|
OBJECTIVE
WITH REVISIONS
|
4-6. |
Increase
the proportion of patients with treated chronic kidney failure who receive a
transplant within 3 years of registration on the waiting list end-stage
renal disease (ESRD).
Target: 30.51 percent 51
registrants per 1,000 patient years at risk.
Baseline: 41 registrants per 1,000 patient years
at risk (since placed on dialysis) received a transplant within 3
years in 1995-97 23.12 percent of persons under 70
years of age received a transplant within 3 years of renal failure in
1992–94.2
Target
setting method: Better
than the best.
Data
source: U.S. Renal Data
System (USRDS), NIH, NIDDK.
1 Target revised from 51 because of
baseline revision after November 2000 publication.
2 Baseline and baseline year corrected
and revised from 41 and 1995–97 after November 2000 publication.
|
REVISED
OBJECTIVE
|
4-6. |
Increase
the proportion of patients with treated chronic kidney failure who receive a
transplant within 3 years of end-stage renal disease (ESRD).
Target: 30.51
percent.
Baseline: 23.12
percent of persons under 70 years of age received a transplant within 3 years
of renal failure in 1992–94.2
Target setting method: Better than
the best.
Data source: U.S. Renal
Data System (USRDS), NIH, NIDDK.
1 Target revised from 51 because of
baseline revision after November 2000 publication.
2 Baseline and baseline year corrected
and revised from 41 and 1995–97 after November 2000 publication.
|
NO
CHANGE IN OBJECTIVE
(Data
updated and footnoted)
|
4-7. |
Reduce
kidney failure due to diabetes.
Target:
901 diabetic persons with new
cases of ESRD per million population.
Baseline: 1292 diabetic persons with new
cases of ESRD per million population were reported in 1997 (age adjusted to
1999 standard population).2
Target
setting method: Better
than the best.
Data
source: U.S. Renal Data
System (USRDS), NIH, NIDDK.
1 Target revised from 78 because of
baseline revision after November 2000 publication.
2 Baseline and baseline year revised from
113 and 1996 after November 2000 publication. |
ORIGINAL
OBJECTIVE
|
4-8. |
(Developmental)
Increase the proportion of persons with type 1 or type 2 diabetes and
proteinuria who receive recommended medical therapy to reduce progression to
chronic renal insufficiency.
Potential
data source:
National
Ambulatory Medical Care Survey (NAMCS), CDC, NCHS.
|
OBJECTIVE
WITH REVISIONS
|
4-8. |
(Developmental)
Increase the proportion of persons with type 1 or type 2 diabetes and proteinuria
chronic kidney disease who
receive recommended medical therapy evaluation and treatment to
reduce progression to chronic renal insufficiency.
Target
and baseline:
Objective |
Increase the Proportion
of Persons With Type 1 or Type 2
Diabetes and Chronic Kidney Disease Who Receive Recommended
Medical Evaluation and Treatment To Reduce Progression to Chronic
Renal Insufficiency |
2000
Baseline
Percent |
2010
Target
Percent |
4-8a. |
Medical evaluation |
29 |
36 |
4-8b. |
Treatment |
32 |
38 |
Target
setting method:
Better
than the best.
Potential
dData
sources:
National
Ambulatory Medical Care Survey (NAMCS), CDC, NCHS.
Centers for Medicare & Medicaid
Services Standard Analytical Files (SAF), CMS, and U.S. Renal Data
System (USRDS), NIH, NIDDK.
|
REVISED
OBJECTIVE
|
4-8. |
Increase
the proportion of persons with type 1 or type 2 diabetes and chronic kidney
disease who receive recommended medical evaluation and treatment to reduce
progression to chronic renal insufficiency.
Target
and baseline:
Objective |
Increase the Proportion of
Persons With Type 1 or Type 2 Diabetes and Chronic Kidney Disease Who
Receive Recommended Medical Evaluation and Treatment To Reduce Progression
to Chronic Renal Insufficiency |
2000
Baseline
Percent |
2010
Target
Percent |
4-8a. |
Medical evaluation |
29 |
36 |
4-8b. |
Treatment |
32 |
38 |
Target
setting method:
Better
than the best.
Data
sources:
Centers for
Medicare & Medicaid Services Standard Analytical Files (SAF), CMS, and
U.S. Renal Data System (USRDS), NIH, NIDDK.
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