| Course | HC 405 Healthcare Quality |
|---|---|
| Unit | Unit 3 |
| Paper type | Measure fact sheet |
| Length | About 1,050 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BS in Healthcare Administration |
| Updated | October 2026 |
Free sample paper for HC 405 Unit 3
Hemodialysis Vascular Access: Long-Term Catheter Rate, a Measure Fact Sheet for Gulfview Kidney Center
Student Name
Health Care Administration, Herzing University
HC 405: Healthcare Quality
Instructor Name
January 29, 2026
Hemodialysis Vascular Access: Long-Term Catheter Rate, a Measure Fact Sheet for Gulfview Kidney Center
The Measure and Who Publishes It
Name: Hemodialysis Vascular Access: Long-term Catheter Rate. Publisher: the Centers for Medicare & Medicaid Services, which uses it in the End-Stage Renal Disease Quality Incentive Program, where a facility's total performance score can reduce its Medicare payment under 42 C.F.R. § 413.177, and in the dialysis facility results shown on the federal comparison website. The specification used here is the one published in the federal measures manual for the 2025 performance period (Centers for Medicare & Medicaid Services [CMS], 2024).
Type, in Plain Words
The specification calls it an intermediate clinical outcome. In plain words, it is not a final outcome such as death or infection, and not simply a process such as whether a referral was made. It counts a clinical state, a patient still dialyzing through a catheter after three months, that sits between the facility's processes and the outcomes that matter most. Catheters carry a much higher risk of bloodstream infection and other complications than a fistula or graft, which is why national guidance favors permanent access for most patients where it suits the person's life plan and vessels (Lok et al., 2020). A lower rate indicates better quality.
The Decision It Informs
For Gulfview, the number informs one practical decision: whether the facility's process for moving patients from a catheter to a permanent access, referral, surgery, maturation and first use, is working, and for which patients it is not. For the federal program, it informs a payment adjustment and gives patients choosing a facility a comparison point.
Denominator
Population: patient-months in which the patient was at least 18 years old on the first day of the month and received maintenance hemodialysis, in the center or at home, for the complete month at the same facility. Time window: each reporting month, rolled up over the calendar year. The unit of count is the patient-month, not the patient, so a patient treated all year contributes 12 to the denominator.
Numerator
The condition that moves a case into the count: a denominator patient-month in which the patient was on maintenance hemodialysis using a catheter continuously for three months or longer, as of the last hemodialysis session of the month. A patient who started dialysis with a catheter in October and still has only the catheter at the end of December enters the numerator for December.
Exclusions and the Reasons Behind Them
Patients under 18 on the first day of the month: the measure is specified for adults, whose access options and guidance differ from children's. Patient-months not on hemodialysis, such as months on peritoneal dialysis: those patients do not use a hemodialysis access. Patient-months with less than a complete month at the same facility, including the month of a transfer or modality change: the facility cannot fairly be held responsible for a month it did not fully treat. Patients not on treatment for end-stage kidney disease: they are outside the program. Patient-months in which a patient with limited life expectancy has a catheter: the specification defines limited life expectancy as hospice care in the month, or metastatic cancer, end-stage liver disease, or coma or anoxic brain injury in the past 12 months. For these patients, placing a fistula or graft may not be in their interest, so a catheter is not treated as a failure of care. For the federal program only, facilities treating fewer than 11 eligible patients in the year are excluded, because rates on so few patients are unstable.
Where the Data Come From
Vascular access type is reported monthly by each facility into the federal end-stage renal disease quality reporting system. Facility staff, at Gulfview the vascular access coordinator, enter each patient's access type for the month. Patient assignment to the facility and treatment modality are determined from a combination of that system, Medicare dialysis claims and the medical evidence form completed when a patient starts dialysis. The federal program's contractor assembles the rate from those sources; the facility does not calculate its own official score, although it can and should calculate the same rate from its own records each month to see problems before the official result arrives months later.
A Worked Example From Gulfview's December
In December 2025, Gulfview had 136 patients on its roster: 132 dialyzing in the center and four on home peritoneal dialysis. Six are excluded for December: four home peritoneal dialysis patients, one patient who transferred in on December 9, and one patient under hospice care with a catheter. The remaining 130 adults received maintenance hemodialysis at Gulfview for the whole month, so the denominator for December is 130 patient-months. Of those, 18 were using a catheter as of their last December treatment. Seven of the 18 had started dialysis within the past three months, so they had not yet been using a catheter continuously for three months and are not counted. The other 11 had used a catheter continuously for three months or longer, so the numerator is 11. December's rate is 11 ÷ 130, or 8.5%.
The example shows why the monthly patient-level review matters. Of the 11 patients in the numerator, five have a fistula maturing and expected in use within six weeks, three are awaiting surgery dates, two have declined surgery after discussion with their nephrologist, and one has vessels judged unsuitable for a fistula or graft. Only the three awaiting surgery dates point clearly to a process the facility can speed up.
Gulfview's Result and What It Cannot Tell
Gulfview's internal calculation for 2025 is 9% of eligible patient-months. The number cannot explain itself. It does not distinguish a patient waiting for a fistula to mature from a patient who has declined surgery, or a patient whose veins will not support a fistula. It cannot show whether a catheter was the right choice for an individual, only how often catheters persist. And because the facility enters the access type itself, the rate depends on accurate monthly entries; an access recorded late or incorrectly changes the count. For those reasons, Gulfview reviews every patient in the numerator each month by name, with the reason the catheter remains, so that the measure prompts a conversation about each person rather than a target to be met on paper.
References
Centers for Medicare & Medicaid Services. (2024). CMS ESRD measures manual for the 2025 performance period (Version 10.1). https://www.cms.gov/files/document/esrd-measures-manual-v101.pdf
End-Stage Renal Disease Quality Incentive Program, 42 C.F.R. § 413.177 (2025).
Lok, C. E., Huber, T. S., Lee, T., Shenoy, S., Yevzlin, A. S., Abreo, K., Allon, M., Asif, A., Astor, B. C., Glickman, M. H., Graham, J., Moist, L. M., Rajan, D. K., Roberts, C., Vachharajani, T. J., & Valentini, R. P. (2020). KDOQI clinical practice guideline for vascular access: 2019 update. American Journal of Kidney Diseases, 75(4, Suppl. 2), S1-S164. https://doi.org/10.1053/j.ajkd.2019.12.001
Reading the HC 405 Unit 3 instructions
Unit 3 asks you to write a fact sheet explaining a published quality measure. Expect the measure name and publisher, its type in plain words, the decision it informs, the denominator, the numerator, exclusions with reasons, data sources, a worked example and what the result cannot tell. Students often ask how to explain technical definitions. Translate each term into everyday language, then give the formal rule. Use the publisher's specification, not a summary. Work one real or composite month through the formula, showing who is excluded and why. Explain what decision the measure supports locally. End with what the number hides, such as reasons a patient still has a catheter.
How the HC 405 Unit 3 example is put together
The fact sheet opens with the measure's name, publisher and use in the incentive program. The type section explains why it is an intermediate outcome. The decision section links it to referral, surgery and fistula maturation. The denominator and numerator sections give the rules, including age and the three-month catheter threshold. Exclusions are listed with reasons, such as home peritoneal dialysis patients and limited life expectancy. The data section explains monthly entry into the federal reporting system. The worked example starts from 136 patients on the December roster, removes six exclusions and counts those with long-term catheters. The final section explains that 9% cannot distinguish a patient waiting for surgery from one who declined it.
Where the points sit in the HC 405 Unit 3 rubric
Herzing's rubric for a measure fact sheet usually covers identification, type, purpose, denominator, numerator, exclusions, data and a worked example. The worked example carries the heaviest weight, because it proves the writer can apply the specification and shows readers how the number is built. Identification points reward the official name and publisher. Type criteria look for a plain explanation. Definition credit goes to rules matched to the specification. Exclusion points reward reasons. Data criteria look for the reporting system and who enters data. Limits should show what the number hides. The CMS ESRD measures manual, the Quality Incentive Program regulation and the KDOQI vascular access guideline by Lok and colleagues support the fact sheet.
Common HC 405 Unit 3 mistakes, and how to avoid them
Measure fact sheets in HC 405 Unit 3 tend to falter when the measure is described in general terms instead of its actual rules. Another frequent problem is skipping exclusions or listing them without reasons. Students often omit a worked example. The type is named without explanation. Data entry responsibility is not stated. The decision the measure informs is missing. Limits are ignored, so the number is read as the whole story. The measure name is paraphrased rather than given officially. Finally, work one month through the formula, because graders reward a fact sheet that a new staff member could use to calculate the measure correctly.
Get a HC 405 Unit 3 example written to your instructions
Send the Unit 3 instructions and the rubric from your HC 405 classroom, plus the measure your section assigned or the outcome you want examined. We write a custom example with numerator and denominator stated as conditions, exclusions listed with reasons, data origin named and the lag admitted, back in 24 to 48 hours. The first custom sample is free.
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HC 405 Unit 3 questions, answered
Where are published measure specifications kept?
Federal quality programs post specification manuals for the measures they collect, and measure stewards publish their own technical documents. Those are the sources to work from, because they carry the exact denominator windows and exclusion lists that a secondary summary leaves out. Cite the version and the year, since specifications get revised and two versions of one measure can produce different counts.
Outcome measure or process measure?
Follow your instructions first. Where the choice is yours, take whichever measure you can locate a complete specification for, since the sheet is only as good as the source behind it. Process definitions tend to be tighter and easier to read closely; outcome measures bring risk adjustment, which is worth a paragraph if space allows. State the type in the opening lines either way.
Should I criticize the measure?
The closing section is exactly where that belongs, provided the criticism comes from the specification rather than from instinct. Point at a real exclusion that removes the hardest cases, or an origin that misses events happening elsewhere. Reading a measure honestly is not the same as dismissing it, and a sheet concluding that measurement is imperfect without naming which part is imperfect has said nothing.
Where can I find a free HC 405 Unit 3 sample paper?
The full HC 405 Unit 3 measure fact sheet is free on this page, the long-term catheter rate explained with denominator, numerator, exclusions and a worked month. A fact sheet for another measure can be written to order.
What is the long-term catheter rate in dialysis?
The share of adult hemodialysis patient-months in which the patient used a catheter continuously for three months or longer. CMS uses it in the ESRD Quality Incentive Program. This sample explains it step by step.