Network Council WebEx February 17, 2011

Transcription

1 Network Council WebEx February 17, 2011 The Renal Network facilitates achievement of optimal wellness for all renal disease patients.

2 Housekeeping Notes Click to Minimize Control Panel All phone lines will be muted through the entire presentation. Questions may be submitted by clicking the Questions Pane, located on your GoToWebinar Control Panel. This presentation will be recorded and will be posted to our website. Questions may also be submitted via to Click the + in the Questions Pane. Type your question and click [Send to All] If you don t see a Questions pane, click [View] and then select Questions from the drop down menu. 2

3 Network Council Webinar Agenda Discussion Topic: Discussion Lead: 1. Welcome & Call to Order George Aronoff, MD Paul Palevsky, MD 2. Informational Updates CMS Leadership & Priority Aims Network Re-Design Forum of ESRD Networks 5 Diamond Safety Project CROWNWeb Susie Stark Bridget Carson Shane Perry Rhonda Lockett 3. Disparities Project Report Emil Paganini, MD 4. Quality Improvement Overview 2010/2011 QIWP Project Progress Fistula First Interim Goals & Intervention Assessment Recovered Function Statistics 5. Transplant Referral Projects Transplant Navigator Living Donation Paired Donation 6. Patient Services Report Involuntary Discharge Complaints Grievances Peter DeOreo, MD Sue Kirschbaum, RN Raynel Wilson, RN Judy Stevenson Kathi Niccum Dean Morris 7. Other Business George Aronoff, MD Paul Palevsky, MD 3

4 TRN Demographics* Area ESRD Network 4 Pennsylvania Delaware ESRD Network 9 Indiana Kentucky Ohio Number of Patients 15,194 1,317 7,442 4,838 15,334 Number of Dialysis Facilities Number of Transplant Centers ESRD Network 10 Illinois 16, TOTAL 60,601 1, * December

5 INFORMATIONAL UPDATES Susie Stark Bridget Carson Shane Perry Rhonda Lockett 5

6 TRIPLE AIM: A KIDNEY DISEASE MODEL A strategic plan; Focused on patients and beneficiaries with kidney disease ( CKD and ESRD)

7 Triple Aim: A Kidney Disease Model A report for discussion Developed by the Forum of ESRD Networks Scope of work for Networks is under development To be compatible with the philosophy outlined in Dr. Berwick s Triple Aim 7

8 Goal Better care for individuals Better care for populations Lower costs through improvement For patients with CKD and ESRD, over time and across settings 8

9 Commit to Patient centeredness and engagement Reduce disparities Align the public and private sectors 9

10 To achieve these goals and commitments Utilize as a framework for action the National Priorities Partnership (NPP) recommendations and the HHS National Strategy and Plan 10

11 NPP Recommendations Engage Patients and Families Improve Safety and Reduce Harm Ensure Receipt of Well Coordinated Care Palliative and End of Life Care Equitable Access to Affordable Care Overuse and Waste Improve Population Health Infrastructure Support 11

12 Engage Patients and Families (CKD and early ESRD focused) 1. Deploy shared decision making tools in the following areas= Prevention of ESRD (slow progression): Rationale: slowing progression of ESRD markedly decreases costs and improves outcomes Requirements: National CKD campaign know your number Family history Modality Choice: Rationale: Home therapies are less expensive, have superior to equivalent outcomes, and empower patient Promote medical management without dialysis and no treatment choice Transplantation Mental Health Issues advocacy for appropriate mental health interventions Health literacy Rehabilitation 2. Use results of patient experience of care and patient satisfaction surveys such as ICH- CAHPS (In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems) Other activities for future consideration Create a clearinghouse of patient educational materials and deploy at the point of care and concurrent with care delivery

13 Critical Success Factors Buy-in and engagement of all public and private sector stakeholders Appropriate authority and the ability to establish relationships for the Networks to engage over time and across settings, i.e. not be confined to the ESRD patient population and the dialysis facilities Sufficient funding. 13

14 Next steps Engage in discussions and seek approval from CMS Review the legislative mandate authorizing the ESRD Network Program Engage in discussions and seek buy-in from the individual Networks and the relevant stakeholders Create multi-stakeholder workgroups to develop plans, with phased role out, for the support infrastructure priority recommendations ( list the support priorities) Conduct prioritizations exercises for the implementation priorities ( list the 7 priorities) (create criteria for conducting the priorities, e.g. cost and frequency burden, potential for improvement, difficulty in conducting the improvement) Consider establishing a steering committee to facilitate continued buy-in and action. 14

15 5 Diamond Patient Safety Program The Renal Network launched the 5 Diamond Safety Program throughout ESRD Network 4, 9 and 10 in May 2010 The program is voluntary & participants are recognized as they attain Diamond Status by completing one or more safety modules We are planning future WebEx training sessions to encourage more facilities to enroll The program goals are To build a patient safety culture in every dialysis unit To promote patient safety values To create an awareness of patient safety issues To help dialysis units learn more about specific areas of patient safety 15

16 5 Diamond Patient Safety Program Modules: Patient Safety Principles (the only mandatory module) Decreasing Patient & Provider Conflict Emergency Preparedness Flu Vaccination Hand Hygiene & Infection Control Medication Reconciliation Missed Treatments Health Literacy Patient Self-Managed Care Sharps Safety Slips, Trips & Falls Stenosis Surveillance 16

17 Current Progress Network 4 44 Facilities Participating (16% of all facilities) 40 Diamonds Awarded Network 9 41 Facilities Participating (8% of all facilities) 17 Diamonds Awarded Network Facilities Participating (4% of all facilities) 9 Diamonds Awarded 17

18 CROWNWeb Update CROWNWeb 2.0 (Phase 3) -- moved to April 2011 Reason for delay: Development of a new QualityNet Identity Management System Current users will be converted to the new identity management system Will utilize multifactor authentication methodologies Networks 4, 9 & 10 have met CMS requirement for acquiring units to participate in CW2.0 > 60 units across TRN will be using CW 18

19 CROWNWeb Update CROWNWeb 3.0 (National implementation) -- Summer 2011 Many change/enhancement requests made in Phases 1 & 2 will be implemented Look of the screens and the flow of information will improve Expectation of additional CPMs will be supported More reports for users and access to data by Networks Additional training should be offered approximately six weeks prior to release date, and is available online 19

20 CROWNWeb Update CROWN Help Desk continues to be the primary point of contact for items related to: Application functionality Business processes Batch data support & delegation of authority forms Hardware/connectivity issues Enhancement request QIPS ID & Password support Knowledge base 20

21 CROWNWeb Update

22 DISPARITIES PROJECT REPORT Emil Paganini, MD 22

23 Project Aims To determine characteristics of facilities who will have reduced payments under proposed changes To determine characteristics of patients at those facilities

24 Methods Networks aggregated and deidentified datasets Raw files n=189,973 patients & 2928 facilities URR and Hgb data for 2007 & 2009

25 Methods Limited dataset Age 18+ years In-center, self & frequent in-center hemodialysis modalities Facilities with 30+ outpatient HD pts Merged patient, facility & geographic variables Computed Total Performance Score per CMS Medicare Fact Sheet July 26, 2010

26 Results Data Analysis will be completed in early spring Networks will work with at-risk facilities to improve outcomes 26

27 QUALITY IMPROVEMENT OVERVIEW Peter DeOreo, MD Sue Kirschbaum, RN Raynel Wilson, RN

28 Quality Improvement Work Plan Projects Contract Task Network 4 Networks 9 and 10 Task 1- Vascular Access Providers AVF rate 55-62% (Promising Stars) Placement and Assessment of Fistula-Providers AVF <55% Placement and Assessment of Fistula (<55%) Promising Stars Focus Group (55-62%) (ALL Catheter Reduction - >27%) Task 2 CPM Anemia Management Increasing Serum Phosphorus Percentage Task 3- Network Specific Increase Patient Hepatitis B Immunizations Improving Dialysis Patient Influenza Immunization Rates Task 4 Facility Specific Decrease Catheters >90 Days Catheter Out/Fistula In ALL Catheter Rate 28

29 Task 1a Vascular Access

30 Vascular Access Performance Targets Network 4 Network 9 Network10 Fistula Rate - 3/31/ % 51.1 % 54.2% CMS Goal - 3/31/ % 54.1% 56.6% Percentage Point Increase Needed Fistula Rate 12/ % 53.6% 56.6% Variance From Goal +0.6 Met Goal Met Goal 30

31 Prevalent Fistula Change Rates Mar-10 Dec-10 Percentage Point Change IN 47.9% 50.4% 2.5 KY 57.9% 61.3% 3.4 OH 50.5% 52.8% 2.3 Net % 53.6% 2.5 (3.0) IL/ Net % 56.6% 2.4 (2.4) DE 63.5% 64.9% 1.4 PA 53.3% 56.4% 3.1 Net % 57.1% 3.0 (2.4) US 55.2% 57.4% (November 2010) 2.2 (2.2) 31

32 Vascular Access Interventions NW4, 9 &10 Medical Director/Facility Administrators/Nurse Manager Letters for Poor Performers Physician Specific Incident CKD Patient Vascular Access Data Report Facility- Specific Monthly Vascular Access Comparative Report VAC & Medical Directors Newsletters (E-VAC NW9/10, enews NW4) Cannulation training Collaboration projects with stakeholders (Coalition, QIOs, NKF, ANNA, Hospital affiliations, LDOs, VAC centers) Website postings Patient education/ Patient workshops

33 Vascular Access QIP Group Interventions Development of 3 P s resource (Prevent Catheter, Place & Use Fistula, Preserve Fistula) Medical Director Letters Facility Root Cause Analysis Educational Learning Sessions in 3 Cities (required for QIPs/open to all) Hosted 2 Vascular Access Management WebExes (required for QIPs/open to all) Individual Group QIP Conference Calls Facility Site Visits Facility Conference Calls with MRB Rep & CMS Follow-up s to administration 33

34 Network: 4 QIP Title: Task 1.a-Vascular Access Goal: All eligible HD patients have AVF as primary vascular access Baseline Measure: 54.1% (March 2010) CMS Target: Increase prevalent AVF rate to 56.5% (Met CMS goal October 2010) Interventions: (1) Network-wide (2) Providers AVF rate 55-62% -on target (3) Providers AVF <55% -on target Interim measure: o AVF rate 57% (Dec 2010) 34

35 Network: 9 & 10 QIP Title: Task 1.a-Vascular Access Goal: All eligible HD patients have AVF as primary vascular access Baseline Measure (March 2010): Network 9 = 51.1% Network 10 = 54.2% CMS Target: Increase prevalent AVF rate to: Network 9 = 54.1% Network 10 = 56.6% (Met CMS goal December 2010) Interventions: (1) Network-wide (2) Providers AVF rate 55-62% - both Networks on target (3) Providers AVF <55% - Network 10 on target (4) Catheter reduction - both Networks on target Interim measure: o AVF rate (Dec 2010): Network 9 = 53.6% (-0.5) Network 10 = 56.6% (Met Goal) 35

36 Task 1b CPM Plan

37 Network 4- QIP Title: Task 1.b Anemia Management Goal: or maintain # patients with Hgb <10 # patients with Hgb between by 1% Baseline Measure: 5.8% < 10g/dL (ELAB 2009) 10.75% (AMGEN Anemia Report March 2010) Interventions: Anemia Management Toolkit resource Focus Group trial communication form to improve ESA dosing when hospitalized WebEx learning session- Potential Clinical Consequences of the Revised Prospective Payment System for Patients on Dialysis -Focus on Anemia Website postings/ Newsletters

38 Network: 4 QIP Title: Task 1.b Anemia Management Interim Results: - on target AMGEN NETWORK ANEMIA REPORT Jun Jul Aug National Jun Jul Aug National HGB <10 g/dl 10.3% 10.1% 10% 9.9% 11.6% 11.7% 11.4% 10.9% HGB g/dl 57.2% 55.2% 55.9% 55.2% 62.2% 62.5% 64% 59.6% HGB >12 g/dl 32.5% 34.8% 34.1% 34.9% 26.3% 25.9% 24.6% 29.5% Network 4 rank: #1 (of all Networks) in the percent of patients with a hemoglobin #1 in percentage of patients with hemoglobin >12 g/dl. Focus Group- 100% form usage Improved reciprocal communication, facilities received more pertinent info, enhanced working relationships between care settings

39 Networks 9 & Phosphorus Control QIP Goal: At least 10 of 16 participating facilities in Network 9, and 4 of 6 in Network 10 (IL) will increase the percentage of patients with serum PO4 between mg/dl by at least 5% by September 2011 and sustain through March Target: At least 5% improvement from facility baseline Interventions: Facilities: 1. provided two patient education sessions 2. submitted patient specific barriers to phosphorus control 3. submitting monthly patient specific phosphorus levels 4. attending scheduled conference calls to troubleshoot and ask questions Interim Results September 2010: Network 9 = 10 of 16 facilities met goal(achieved Goal) Network 10 = 4 of 6 facilities met goal (Achieved Goal) Will evaluate sustainability to March

40 Task 1c Network Specific QIP

41 Network: 4 QIP Title: Task 1.c. Immunization Goal: To rate of patients immunized for Hepatitis B Baseline Measure: 78.1% immunization rate (3/2010) Target: To # patients immunized by 5% NW-wide Interventions: Distribute Hep B tool-kit Provide tools /resources that address CfC & CDC guidelines for immunization Provide QAPI guidelines for Hep B monitoring & surveillance WebEx Provide tracking tools for HEP B vaccines Patient education & brochures Re-scan (clarify questions) to measure any improvement for 2010

42 Network: 4 QIP Title: Task 1.c. Immunization Hepatitis B Immunization practicesbaseline scan results: 60% providers responded to scan 100% indicated that they track the immunizations 90% reported that the Hepatitis B tracking is incorporated into the facility CQI/QAPI program. Next Step: re-scan for Hep B immunization rates

43 Networks 9 & Improving Dialysis Patient Influenza Immunization Rates Goal: At least 60% of the participating facilities will increase the percentage of patients receiving the influenza vaccine by at least 5% from the 2009 flu season 2010 flu season. Target: At least 5% improvement from facility baseline Interventions: Facilities: 1. send a facility 2009 flu vaccination rate assessment scan to determine baseline 2. influenza vaccination tools will be distributed Network-wide 3. facility staff attend a flu immunization WebEx in November send a follow-up facility assessment scan asking How will you change to make improvements 5. re-measure with a facility 2010 flu vaccination rate assessment scan to assess if the goal was reached and to assess the effectiveness of the project and practice change for flu season Return rate = At least 90% of assessment scans returned by end of January 2011 Return Rate Results January 2011: Network 9 = 90.6% returned (Exceeds Return Rate Goal) Network 10 = 90.0% returned (Met Return Rate Goal) 43

44 Task 1d Facility Specific Quality Assessment and Improvement Project

45 Network 4: Catheter Reduction QIP Goals: 80% of facilities with a long-term catheter rate (> 90 days) with a >25 % will implement an acceptable protocol or QI plan to reduce long-term catheter usage. 60% of facilities will reduce #patients with LT catheter by 3% Facility selection criteria: Chronic catheter rate 25% Facility census (March 2010) 30 patients Not selected for any other QIP Interim results: (December 2010): GOAL MET 100% have implemented an acceptable corrective action plan Catheter 60% of the targeted providers decreased catheter rate by 3% or greater The average LT catheter rate decreased by 6.2%, from 32% to 25.8%

46 Networks 9 & Catheter Out/Fistula In Goal: At least 60% of targeted facilities will decrease the number of patients with a catheter by 20% by March Target: reduce ALL catheter rate 20% from facility baseline Interventions: Facilities: 1. submit a root cause analysis and catheter reduction action plan to the Network 2. attend a QAPI/Vascular Access Management Best Practice WebEx in August 2010 and January attend Vascular Access Management Learning Session based on preventing catheters, placing and using fistula, and preserving fistula 4. utilize the tools and resources from the 3Ps Vascular Access Management Handbook 5. submit updated action plans quarterly Interim Goals : At least 15% of facilities will decrease their ALL catheter rate by at least 5% each quarter to reach at least 60% of facilities decreasing their ALL catheter rate by at least 20% by March December 2010 Results: Network 9-46% facilities reduced % ALL catheter usage by at least 15% (surpassed December interim goal of 45%) Network 10-50% facilities reduced % ALL catheter usage by at least 15% (surpassed December interim goal of 45%) 46

47 RECOVERED FUNCTION STATISTICS 47

48 9.00% % of Total Incident Patients Recovering Function within 90 Days Patients Recovering Kidney Function 8.00% 7.00% 6.00% 5.59% 5.00% 4.00% 3.00% 4.76% 4.24% 3.81% NW4 NW9 NW10 TOTAL NW Δ 4 1.9% 4.2% 2.3% 9 2.5% 5.6% 3.1% 2.00% 2.53% 1.99% % 3.8% 1.8% 1.00% Nation 2.2% 4.8% 2.6% 0.00% 9.00% 8.00% 7.00% % of Total Incident Patients Recovering Function within 1 Year % 6.81% Data indicates all Networks are experiencing an increase in the percentage of patients recovering kidney function from 1999 through % 6.00% 5.38% 5.00% NW4 4.00% 3.00% 4.10% 3.30% 2.75% 3.57% NW9 NW10 TOTAL NW Δ 4 2.7% 6.4% 3.6% 2.00% 9 4.1% 7.8% 3.7% 1.00% % 5.4% 2.1% 0.00% Nation 3.5% 6.8% 3.3%

49 TRANSPLANT REFERRAL PROJECTS Judy Stevenson, RN 49

50 ORGAN PROCUREMENT/TRANSPLANTATION COMMITTEE Network 4 has engaged Amy Waterman to present her program, Explore Transplant. It uses a train the trainer approach to help patients make informed decisions on both deceased and living donor transplant options. One program in Philadelphia March 30 One Program in Pittsburgh - April 12 Transplant centers will attend and also be vendors OPO agencies have volunteered meeting space 50

51 OP/TC (CONTD) Dr. Ash Segal presented an NIH-funded trial he would like the Network to participate in. The premise is that transplant recipients can be used as navigators to assist other patients through the transplant process. Transplant centers in The Renal Network were contacted and participated on a conference call this month. The centers that agree to participate in the study will contribute $16,000 towards the salary of the navigator. Data will be collected to determine the impact on referrals. 51

52 Transplant Collaborative Regional Project Networks 4, 9 & 10 Network 11 Network 12 CMS Kansas City Regional Office Educational Focus Explore Transplant Transplant Navigator Donation Options WebEx Platform Objective: Increase awareness of dialysis facility staff and develop processes that lead to increase transplant referral rates. 52

53 PATIENT SERVICES REPORT Kathi Niccum Dean Morris

54 Network Intervention for Patients At-Risk for Discharge Year Network 9/10 Project # Pts at Risk for IVD % % Total 114 4% *Data for January October 2010 % Pts discharged within the first 3 months after NW intervention

55 NW Interventions for At-Risk Patients Adherence issues/ Toolkit Mental health issues Coping skills for patients Anger management Discussed Conditions for Coverage Staff education Follow up

56 YEAR Network 4 Involuntary Discharges: Total Discharges Demographics 2010 % % % % > 74 % Male % Female % Black % White 2010 IVD 36 29% 59% 3% 9% 62% 38% 59% 41% Network 4 Total Patient Population 13% 40% 22% 25% 56% 44% 36% 62% YEAR Network 9/10 Total Discharges % % % % > 74 % Male % Female % Black % White 2010 IVD 34 24% 59% 8.5% 8.5% 79% 21% 50% 50% Network 9/10 Patient Population 13% 41% 23% 23% 56% 44% 37% 61%

57 NW Interventions for IVD Patients Discussed Conditions for Coverage Coping skills for patients Mental Health issues Anger management Advocated for patient rights Educated staff Referenced DPC material

58 Total 2010 Beneficiary Complaints, Facility Concerns, Grievances, and Involuntary Discharges Complaints Facility Concerns Grievances Involuntary Discharges Network Network Network

59 New & Upcoming Resources Exercise Resources Rehabilitation Brochure FF Gold Standard Poster & Stories Professionalism from the Patient s Viewpoint

60 OTHER BUSINESS George Aronoff, MD Paul Palevsky, MD 60