Home Dialysis Referral: New Shift

Home Dialysis Referral: New Shift 2017 AIM 2 Quality Improvement Activity ANDREA MOORE Quality Improvement Coordinator

Agenda CMS Statement of Work (SOW) Rewind: Another Look at the CMS Definition of Referral Project Requirements & Responsibilities Project Timeline Disparity Deep Dive Identifying Areas of Opportunity New Shift Data Collection Resource Review #ENGAGE Campaign Next Steps Questions?

AIM 2 QIA 2017 Promote Appropriate Home Dialysis in Eligible Patients Domain: Population Health Focused Pilot Project (PHFPP) Scope: 5% of In-Center ESRD Population Objectives: o Increase frequency of home referrals in eligible patients o Identify disparity Goals: o 5% increase in the rate of home dialysis referrals for eligible patients (Exceeded Goal = 14.8%) o 1% reduction in the identified disparity for the cumulative outcome measure Disparity 1% 5% Total Referrals

CMS Home Dialysis Referral Definition Home Dialysis Consultation Referral Date: The date in which a patient is referred or scheduled to meet with an appropriate home dialysis staff. Home Dialysis Consultation Date: The date in which a patient meets one-on-one with appropriate home dialysis staff. Referred Patient: CMS defines a referred patient as one who has BOTH a referral date AND a materialized one-on-one home dialysis consultation date.

Project Requirements and Responsibilities Submit all required data and documentation by the due date Register for and participate on scheduled webinars Failure to observe project requirements and responsibilities will result in: One email notice One notification via phone If attempts to contact facility go unsuccessful the Network will: Report facility to the corporate leadership (if applicable) Report facility s failure to meet project requirements and responsibilities to the appropriate State Survey Agency Report facility to CMS

Project Timeline New Shift: Home Dialysis Referral Facility Kickoff Webinar Plan-Do-Study-Act Cycle (PDSA Cycle) #ENGAGE Campaign Root Cause Analysis (RCA) MEI Decision Aid New Shift Readiness Sustainability Action Plan Data Collection Disparities in ESRD

Project Timeline Phase 1 New Shift January - February New Shift: Home Dialysis Referral Kickoff Webinar Home Dialysis Referral Process & Checklist Establish New Shift Home Therapy Team Documenting and Tracking Referrals RCA How-to New Shift Data Collection Tool Identify Home Dialysis Champions Data Collection Tool Due: February 15 Phase 2 Root Cause Analysis (RCA) February - March RCA Due on Friday, February 3 Pre-New Shift Readiness Environmental Scan Introduce/Test MEI Decision Aid New Shift Webinar Friday, February 17 Data Collection Tool Due: March 1 Phase 3 - Engage & Educate March April MEI Dialysis Decision Aid Feedback & Patient Questionnaire PDSA How-to Disseminate Shift to Home Podcast Series Data Collection Tool Due: April 3 Phase 3 - Engage & Educate March April Disseminate Shift to Home Podcast Series Data Collection Tool Due: April 3 Phase 4 Disparities in ESRD April May Disparities in ESRD Webinar April 20 Disparity Deep Dive Data Collection Tool Due: May 1 Plan/Execute #ENGAGE Campaign Document/Capture #ENGAGE Campaign Phase 5 - #ENGAGE Campaign June July Execute #ENGAGE Campaign Document/Capture #ENGAGE Campaign Present #ENGAGE Campaign Disparity Deep Dive Develop project sustainability action plans Data Collection Tool Due: June 1 Data Collection Tool Due: July 3 Phase 5 Shift to Sustainability August October Disparity Deep Dive Review and share sustainability plans Data Collection Tool Due: August 1 Data Collection Tool Due: September 5 Final Data Collection Tool Due: October 2

Disparity Deep Dive Disparities Defined: Disparity (dis per ә tē) n. a difference or lack of equality/ --pl. ties Health Disparity population-specific differences in the presence of disease, health outcomes, or access to health care. -Health Resources and Services Administration Health Care Should Be: Safe Effective Patient-centered Timely Efficient Equitable = providing care that does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographic location or socio-economic status. -Institute of Medicine

Disparity Deep Dive 10.00% 9.4% 9.00% 8.00% 7.00% 7.1% 6.00% 5.00% 5.8% 4.8% 6.9% 4.00% Baseline February March April Disparity Goal Source: NCC Working Report PHFPP Prevalence Table

Cumulative Disparity Performance Facility CCN Baseline FEB MAR Goal #1 APR MAY Goal #2 JUN JUL Goal #3 Project Goal 212537 13.11% -2.05% -5.00% 12.86% -4.03% 12.61% 12.36% 12.11% 212605 4.19% 1.50% 3.52% 3.94% 3.17% 3.69% 3.44% 3.19% 492505 3.51% 3.51% 11.70% 3.26% -2.91% 3.01% 2.76% 2.51% 492506 2.93% 3.46% 7.00% 2.68% 4.98% 2.43% 2.18% 1.93% 492552 2.91% 7.98% 6.32% 2.66% 9.25% 2.41% 2.16% 1.91% 492564 6.25% 7.20% 11.75% 6.00% 11.35% 5.75% 5.50% 5.25% 492587 6.24% 5.78% 5.40% 5.99% -9.38% 5.74% 5.49% 5.24% 492603 5.00% 6.11% 12.25% 4.75% 13.48% 4.50% 4.25% 4.00% 492625 2.94% 3.13% 2.78% 2.69% -3.51% 2.44% 2.19% 1.94% 492634 4.91% 8.17% 7.63% 4.66% 13.77% 4.41% 4.16% 3.91% 492662 6.39% 14.17% 13.76% 6.14% 14.44% 5.89% 5.64% 5.39% 512503 5.71% 8.49% 14.56% 5.46% 13.89% 5.21% 4.96% 4.71% 512533 11.54% 11.88% 8.20% 11.29% -10.56% 11.04% 10.79% 10.54% 5.80% 7.11% 9.4% 5.47% 6.9% 5.14% 5.05% 4.80% Facilities Highlighted in Green Met Goal #1 May provides the opportunity to meet Goal #2

Areas of Opportunity to Close the Disparity Gap

Areas of Opportunity to Close the Disparity Gap Identified windows of opportunity: Treatment Start Year 2016-2017 Patient age less than 65 years old Identify patients that meet both of these criteria

Areas of Opportunity to Close the Disparity Gap 180 160 140 120 100 80 60 40 20 0 Treatment Start Date 160 134 85 74 75 38 22 1 1 4 11 5 8 10 13 2000 2001 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 # In-center HD Patients Area of opportunity Note: 235 patients started in-center hemodialysis between 2016-2017 Source: NCC Working Report PHFPP Prevalence Table delivered 5/11/2017

Areas of Opportunity to Close the Disparity Gap 400 363 350 300 278 250 200 150 100 50 0 Less than 65 years old Greater than or equal to 65 years old # of Patients Area of opportunity Patient Age Note: 363 patients are less than 65 years old Source: NCC Working Report PHFPP Prevalence Table delivered 5/11/2017

Areas of Opportunity to Close the Disparity Gap 120 100 80 60 40 20 0 106 54 38 2016 2017 <65 >65 37 144 patients started dialysis in 2016 or 2017 and are less than 65 years old 33 of the 144 patients potentially eligible for referral have previously been referred 111 patients remain in the target intervention group Source: NCC Working Report PHFPP Prevalence Table delivered 5/11/2017

Areas of Opportunity to Close the Disparity Gap CCN # AA Patients starting ICHD in 2016; < 65 years old # AA Patients starting ICHD in 2017; < 65 years old AA Pts Potentially Available for Referral* AA Referrals Needed to Close the Disparity Gap 212537 3 0 3 0 212605 11 4 15 3 492505 4 0 4 0 492506 2 3 5 3 492552 11 1 12 6 492564 10 3 13 6 492587 1 0 1 0 492603 2 0 2 7 492625 6 1 7 0 492634 21 3 24 19 492662 16 1 17 14 512503 3 1 4 4 512533 3 1 4 0 93 18 111 62 Note: Patients referred since April 2016 have been removed from this target group *Potentially available for referral is defined as patients eligible for referral based on treatment start date and age Source: NCC Working Report PHFPP Prevalence Table delivered 5/11/2017

Home Referral Barriers Deep Dive 7% 10% 5% 3% Patient Refusal (Long-term) Lack of Support Medically Ineligible 8% 11% 56% Unstable Housing Poor Self-management Nursing Home Resident

Interventions, Strategies, and Resources Partner with Patient Representatives/Liaisons The Network (QIC/PSD) will co-facilitate a conference call with Network Patient Subject Matter Experts (SMEs) from the Patient Advisory Council (PAC) Conference call to review the purpose of New Shift and brainstorm with patients strategies and interventions to reduce the disparity and bring awareness about home therapies from a peer-to-peer perspective. Identifying Eligible Patients Questionnaire adapted from pre-dialysis patient questionnaire MEI MATCH-D Tool MEI Dialysis Decision Aid Strategies & Educational Tools for Promoting Appropriate Dialysis Webinar Presentation by Dori Schatell Individualize patient engagement and education Peer-to-Peer/Patient-to-Patient Education & Engagement Shift to Home Podcast Series #ENGAGE Campaign Cross-Training & Integrating an Interdisciplinary Approach Ongoing communication, partnership, and cross-training between in-center staff and home therapy staff. IDT meetings that include the perspective and expertise of the social worker to highlight possible interventions for addressing socio-economic barriers Patients evolve, as do their needs and desires. An initial refusal may not be permanent. Develop a standardized process/talking points to re-approach patients to engage them in discussion about home therapies.

Interventions, Strategies, and Resources

Interventions, Strategies, and Resources

Interventions, Strategies, and Resources

Interventions, Strategies, and Resources Shift to Home Podcast Series

#ENGAGE Campaign If you have not already launched and captured, by way of photos, video, story boards, etc. you have until June 12 th to launch and capture your #ENGAGE Campaign. The #ENGAGE Campaign should include: Patient engagement How were your patients/patients family engaged in two-way communication and the sharing of information? Education What are you teaching patients? How are you teaching them? Concerted Effort to target disparate population to close the disparity gap Creativity Team work/partnership between in-center and home therapy staff/teammates Inclusion of resources and strategies introduced/reviewed throughout project (Disparity Deep Dive Report, MEI Tool, Checklist, Process Map, Shift to Home Podcast Series) Each New Shift facility will prepare 2-3 slides on their #ENGAGE Campaign to present to the group on Friday, June 16 The Network s Patient Advisory Council (PAC) will chose at least one New Shift #ENGAGE winner at the Council Meeting

Next Steps New Shift: Home Dialysis Referral Facility Kickoff Webinar Plan-Do-Study-Act Cycle (PDSA Cycle) #ENGAGE Campaign Root Cause Analysis (RCA) MEI Decision Aid New Shift Readiness Sustainability Action Plan Data Collection Disparities in ESRD

Next Steps ATTEND THE STRATEGIES & EDUCATIONAL TOOLS FOR PROMOTING APPROPRIATE DIALYSIS THERAPIES PRESENTATION ON TUESDAY, MAY 23 PLEASE RETURN THE PATIENT REP AND EVENT DATE FORM BY WEDNESDAY, MAY 24 SUBMIT MAY HOME DIALYSIS REFERRAL DATA NO LATER THAN THURSDAY, JUNE 1 CONTINUE TO UTILIZE AND DOCUMENT MEI TOOL WITH A GOAL OF ¼ OF IN- CENTER PATIENTS TESTING THE TOOL BY JULY 31 EXECUTE AND DOCUMENT/CAPTURE #ENGAGE CAMPAIGN PREPARE TO PRESENT #ENGAGE CAMPAIGN ON FRIDAY, JUNE 16TH UPDATE PERSONNEL IN CROWNWEB

Questions? Andrea Moore amoore@nw5.esrd.net 804.320.0004 ext. 2714 804.320.5918