When to Use
Use it once a month, before the mandated CQI meeting, to convert the month's raw data into a governed decision. It benchmarks each key performance indicator (KPI) against the Section-6 targets of the QAPI vs. CQI field manual — Kidney Disease Outcomes Quality Initiative (KDOQI) adequacy, Kidney Disease: Improving Global Outcomes (KDIGO) anemia & chronic kidney disease–mineral and bone disorder (CKD-MBD), International Organization for Standardization (ISO) 23500 water, Centers for Disease Control and Prevention (CDC) / National Healthcare Safety Network (NHSN) infection, and Philippine Society of Nephrology (PSN) 2024 cadences/ratios — computes domain scores and a Unit QAPI Index, flags special-cause candidates, and drafts a PDSA charter stub for every red metric. It is a decision aid for the leadership team — the Medical Director / Dialysis Clinical Head (DCH), Head Nurse, Unit Operations Manager (UOM), and quality officer — not a substitute for clinical judgment or your registry software.
How It Works — logic & scoring
Bands. Each metric is scored GREEN / AMBER / RED against its target (defaults from the field manual's Section 6; edit them in the advanced panel to localise).
Bloodstream infection (BSI) rate = (BSI events ÷ patient-months) × 100, compared to the ~0.5/100 patient-months benchmark.
Domain score = weighted % of that domain's metrics that are green (amber = half credit; blank = excluded). Unit QAPI Index = mean of the domain scores that have data. Both are shown as gauges.
Hard reds (non-negotiable) force an RCA prompt and cannot be scored away: any hepatitis B / C virus (HBV / HCV) seroconversion; water colony-forming units (CFU) ≥ 100 or endotoxin ≥ 0.25 endotoxin units per millilitre (EU/mL); an overdue chemical water analysis; chloramine over limit; any intradialytic/immediate death.
Special-cause helper. Paste a metric's last ≥ 8 monthly values and the tool applies simple run-chart rules (a shift of ≥ 6 points on one side of the median, or a trend of ≥ 5 successive rises/falls) and tells you "possible special cause — investigate" vs "within expected variation — do not tamper."
The Scorecard
Enter the month's numbers. Leave anything you don't have blank. Targets are shown beside each field.
Advanced — special-cause helper (run-chart rules)
Paste one metric's last 8+ monthly values (comma- or space-separated), oldest first. Optionally set an upper control limit.
Advanced — edit thresholds & weights
The scorecard ships with the field-manual defaults. To localise a target, edit its green/amber value below (direction is fixed per metric), then re-compute. Domain weights are equal by default; change any to re-weight the Unit QAPI Index.
Where the Numbers Come From
Default targets and cadences are drawn from the same core sources as the parent field manual: KDOQI 2015 hemodialysis adequacy (single-pool Kt/V (spKt/V) target 1.4, min 1.2; urea reduction ratio (URR) ≥ 65%); KDIGO anemia (hemoglobin (Hb) ~10–11.5 g/dL, transferrin saturation (TSAT) / ferritin-guided iron) and CKD-MBD (individualised calcium / phosphate / parathyroid hormone (PTH)); ISO 23500 / Association for the Advancement of Medical Instrumentation (AAMI) water quality (< 100 CFU/mL, < 0.25 EU/mL, action levels 50 CFU/mL and 0.125 EU/mL); the CDC/NHSN dialysis-event method and its ~0.64 per 100 patient-months pooled BSI benchmark (2.16 for catheters); the Centers for Medicare & Medicaid Services (CMS) QAPI five-element framework; and the PSN 2024 HD Guidelines for the Philippine metric list, monthly/six-monthly water cadences, and staffing ratios. Full citations are in the References block, and every target is explained in the QAPI vs. CQI field manual, Section 6.
