Florida Renal Administrators Association Meeting Bold Goals and New Priorities: An ESRD Network Update Donna DeBello, RN Quality Improvement Director HSAG: The Florida End Stage Renal Disease (ESRD) Network July 20, 2018
Objectives Provide an update on Network staffing and Florida s ESRD demographics Discuss Health and Human Services (HHS) priorities and Centers for Medicare & Medicaid Services (CMS) goals Review 2018 Network quality improvement activities (QIAs) and Network resources 2
The HSAG: End Stage Renal Disease (ESRD) Networks 3
Network 7 Quality Improvement Staff Donna DeBello, RN Quality Improvement Director 813.865.3363 DDeBello@nw7.esrd.net Robert Peck, RN Quality Improvement Coordinator 813.865.3474 Rpeck@nw7.esrd.net Stephanie Hull Nephrology Nurse 813.865.3454 Shull@nw7.esrd.net Bonnie Grasso, MSW Quality Improvement Manager 813.865.3415 BGrasso@nw7.esrd.net HSAG: The Florida ESRD Network (Network 7) 3000 Bayport Drive, Suite 300, Tampa, Florida 33607 Phone: 813.383.1530 Fax: 813.354.1514 4
Network 7 Patient Services and Data Management Staff Melissa Perry, LCSW Patient Services Manager 813.865.3368 MPerry@nw7.esrd.net LeChrystal Williams Data Manager 813.865.3323 LWilliams@nw7.esrd.net 5
Florida s ESRD Demographics 2015 2016 2017 Incidence 7,970 8,301 8,240 Prevalence 29,119 30,425 31,600 Home Dialysis 3,289 2,225 3,859 Hemodialysis 568 388 642 Continuous Ambulatory Peritoneal Dialysis (CAPD) 386 255 407 Continuous Cycling Peritoneal Dialysis (CCPD) 2,334 1,581 2,807 Kidney Transplant 996 864 1,058 Patient Deaths 5,129 5,254 5,881 Vocational Rehabilitation 24% 25% 21% Dialysis Facilities 425 450 473 Transplant Center 8 9 10 6
HHS Priorities 7
CMS Goals 8
Bold Goals for Networks 9
QIA Spread QIA Number of Network 7 Facilities Total Network Facilities 425 Increase Patients On a Kidney Transplant Waitlist 123 Increase Patients That Start Home Dialysis Training 118 Decrease BSIs/LTC Use 200 Population Health Focused Pilot QIA (Network 7: Pain Management) 44 Total: 485 Facilities 10
Network QIA Structure 11
National Patient Affinity Groups Affinity Groups include patient subject matter experts (SMEs) from all 18 Networks. Patient SMEs chose to participate with one of the following QIA Learning and Action Networks (LANs): BSI Home Dialysis Transplant Mental Health Networks are mandated to implement patient- level educational resources developed or identified by the National Patient Affinity Groups in QIAs. 12
2018 QIA LANs A LAN is an improvement initiative that brings together healthcare professionals, patients, and other stakeholders to achieve rapid, wide-scale improvement. Learn more about LANs here: https://www.youtube.com/watch?v=zunezrijsbk. 2018 LANs focus on: Reducing BSIs. Increasing patients on a transplant waitlist. Increasing patients that start home dialysis training. The QIA LANs are hosted by the ESRD National Coordinating Center (NCC). Meetings are held every other month. Meeting invitations will be sent to facilities from the Network. Interventions identified in the LANs will be included in the QIAs. 13
BSI QIA: Goals and Status Goals include: Working with patients to impact their own care. Demonstrating a 20.0% or greater relative reduction in pooled mean BSI rate. Using Centers for disease Control and Prevention (CDC) intervention materials (e.g., audit tools). Status of BSI rate reduction: Number of Facilities Number of Patients Baseline (1/1 6/30/ 2017) Current (May 2018) Goal (1/1 6/30/2018) 80 5,521 1.370.621 0.892 A lower rate indicates better performance. 14
Engaging Patients as Partners in Infection Prevention 15
LTC QIA Goals and Status Goals include: Implementing LTC reduction activities in BSI QIA facilities that have LTC rates over 15.0%. Reducing the rate of LTC use among prevalent patients by two percentage points. Status of LTC rate reduction: Number of Facilities Number of Patients Baseline (1/1 6/30/ 2017) Current (May 2018) Goal (July 2018) 50 3,441 19.8% 17.8% 17.8% A lower rate indicates better performance. 16
Home Dialysis QIA Goals include: Increasing the number of patients training on home dialysis by ten percentage points Implementing with 30% of Florida s dialysis facilities Status of home dialysis training rate: Number of Facilities Number of Patients Baseline (1/1 6/30/ 2017) Current (May 2018) Goal (Sep 2018) 118 7,761.452%.644% 10.4% A higher rate indicates better performance. 17
Home Dialysis QIA Resources 18
Home Dialysis QIA Resources (cont.) 19
Transplant QIA Goals include: Increasing the number of patients on a transplant waitlist by ten percentage points. Implementing with 30.0% of Florida s dialysis facilities. Status of transplant waitlist rate: Number of Facilities Number of Patients Baseline (1/1 6/30/ 2017) Current (May 2018) Goal (Sep 2018) 123 9,316 6.7% 5.9% 16.7% A higher rate indicates better performance. 20
Transplant QIA Resources 21
Transplant QIA Resources 22
Population Health Focused Pilot (PHFP) QIA: Pain Management Goals and Status Goals include: Reducing the number of patients with response, No documentation of pain assessment, and no reason given to zero. Reducing the number of patients with response, Pain assessment documented as positive using a standardized tool, a follow-up plan is not documented, and no reason is given by 10%. Status: No Assessment No Follow-up Plan Baseline (10/1/2016 6/30/2017) A lower rate indicates better performance. Goal Current (March 2018) 68.500% 00.000% 43.300% 0.879% 0.789% 0.843% 23
Pain Assessment QIA Resources 24
Patient and Family Engagement (PFE) at the Facility Level The Network will focus on assisting QIA facilities in implementing the following PFE activities throughout 2018: Establishing patient councils, patient and family support groups, and/or new patient adjustment groups. Incorporating patient, family, and caregiver participation into the Quality Assurance Performance Improvement (QAPI) Program and governing body of the facility. Developing policy and procedures related to patient, family, and caregiver participation in the patient s care and the development of the individualized plan of care(poc) and POC meetings. 25
Network 7 QIA Facilities PFE Activities Indicator March Goal Establish patient councils, patient and family support groups, and/or new patient support groups Incorporate patient, family, and caregiver participation into the QAPI program and governing body of the facility Develop policies and procedures related to patient, family, and caregiver participation in the patient s POC 7.5% (32/425) 12.2% (52/425) 82.1% (349/425) 10% 10% 30% 26
Questions 27
Thank you! Donna DeBello, RN Phone: 813.865.3363 Email: Ddebello@nw7.esrd This material was prepared by ESRD Network 7, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy nor imply endorsement by the U.S. Government. Publication Number: FL-ESRD-7A2011-06292018-01