Home Dialysis Referral: New Shift 2017 AIM 2 Quality Improvement Activity ANDREA MOORE Quality Improvement Coordinator
Agenda CMS Statement of Work Project Timeline Updated Data Collection Tool Root Cause Analysis Results MEI Dialysis Decision Aid MEI Dialysis Decision Aid Feedback Form PDSA Cycle Patient Questionnaire Next Steps Questions?
AIM 2 QIA 2017 Promote Appropriate Home Dialysis in Eligible Patients Domain: Population Health Focused Pilot Project (PHFPP) Scope: 5% of 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 o 1% reduction in the identified disparity for the cumulative outcome measure Disparate Group 1% 8.97% 4.22% 5%
Project Timeline New Shift: Home Dialysis Referral Facility Kickoff Webinar Plan-Do-Study-Act Cycle (PDSA Cycle) Rapid Cycle Improvement 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 3 - Engage & Educate March April Submit Pre-New Shift Readiness Environmental Scan 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 Data Collection Tool Due: May 1 Plan ENGAGE Initiatives 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 A New Shift ENGAGE Initiatives June July Execute ENGAGE Initiatives Develop project sustainability action plans Data Collection Tool Due: June 1 Data Collection Tool Due: July 3 Phase 5 Shift to Sustainability August - October Submit Post-New Shift Readiness Environmental Scan Review and share sustainability plans Data Collection Tool Due: August 1 Data Collection Tool Due: September 5 Final Data Collection Tool Due: October 2
Updated Data Collection Tool Monthly Data Collection Worksheet February 1 28 Home Referral Data Due on March 1
Root Cause Analysis Results
RCA Patient Related
Agenda Poor/Inconsistent Home Referral Tracking & Monitoring Low Facility Leadership/Physician Support Misconceptions About Home Therapies Low Referral Rates Poor/Absent Home Referral Process Lack of pre-dialysis education Lack of family/care partner support Ranking Order : Poor or inconsistent home referral tracking and monitoring Low facility leadership/physician support Poor/absent home referral process Lack of pre-dialysis education Misconceptions about home therapy Lack of family/care partner support
MEI Dialysis Decision Aid Requirements Disseminate the MEI Dialysis Decision Aid to both in-center staff and home therapy staff. Review and test the Aid at the facility staff-level on multiple devices including, desktop computer, ipad, Smartphone, and laptop. The Aid is not compatible with Kindle. All staff who test the tool will submit the brief MEI Dialysis Decision Aid Feedback Form by Friday, February 24 MEI Dialysis Decision Aid
Plan-Do-Study-Act (PDSA) Cycle
PDSA AIM: Reduce patients misconceptions about home dialysis therapies. Describe your first (or next) test of change: Will utilize the MEI Dialysis Decision Aid to engage patients and serve as a starting point to dialogue that will lead to education on home modality options. Person Responsible Home Therapy Team When to be done March 6 Where to be done In-center clinic List the tasks needed to set up this test of change: 1. Discuss with home therapy team best ways to identify patients to test MEI tool 2. Brainstorm with home therapy team at least one way to make the MEI tool accessible to patients who do not have internet access 3. Obtain the input of patient representative(s) on best ways to solicit patients to test MEI tool 4. Assign a staff member(s) who will help to administer the MEI tool and patient feedback questionnaire 5. Document which of the patients who test the MEI tool request more information about home therapies or home therapy referral 6. Develop educational and engagement materials to provide to patients Person Responsible Home Therapy Team FA/CM MD When to be done February 22 Where to be done QAPI IDT Meeting Home Therapy Weekly Meeting Predict what will happen when the test is carried out: 1. Patients will request additional info/consult with staff to ask questions about home therapies/mei tool results 2. One-on-one home consultations will be generated as a result of using the MEI tool 3. Patient who test the MEI tool, but do not request additional info/consult may still have misconceptions about home therapies Measures to determine if prediction succeeds 1. Count & document the # of patients who tested the MEI tool & asked for additional info/consult or had additional questions after testing the tool 2. Count & document the # of consultations generated by patients who tested the tool 3. Quantify & document the # of pts who self-report having a better understanding of home therapies following testing the tool; compare the self-reported responses of pts who asked for f/u info/consult v. those pts who did not
PDSA Do Describe what actually happened when you ran the test: The tool was disseminated/administered to 3 patients on each shift on Monday, March 6; disseminated to 3 additional patients on the 1 st and 2 nd shift on Tuesday, March 7; and disseminated to 2 more patients, both on 2 nd shift, on Friday, March 10. Staff had to use an ipad to assist patients with the administration of the tool, as some patients were unable to easily navigate the tool using their Smart Phones. Study Describe the measured results and how they compared to the predictions: 1. All 8 of the patients who tested the MEI tool requested to speak to staff to ask additional questions either about home therapies, the results of the tool, or the itself 2. Three of the 8 patients who tested the tool were referred for a one-on-one home therapy consult within 5-7 days of testing the tool. Of the 8 pts who had additional questions/follow-up from home therapy staff, only 5 of them reported having a better understanding of home therapies. Act Describe what modifications to the plan will be made for the next cycle from what you learned: 1. Develop an assessment/quiz to better evaluate patients understanding and reduce misconceptions 2. Set up a MEI Dialysis Decision Aid computer station on the next scheduled home therapy Lobby Days on April 13 and April 14 Add the modifications to the cycle and begin again with developing a plan to include modifications.
PDSA Computer Station in the Lobby Provide Paper Copies of MEI Dialysis Decision Aid Equitable Distribution & Accessibility Smart Phone Staff Administers in Office, at Chairside, or by Phone
MEI Dialysis Decision Aid Patient Questionnaire Requirements Disseminate/administer MEI Dialysis Decision Aid to at least 8 in-center patients by March 14 Provide each patient with a hard copy questionnaire Fax completed patient questionnaires to 804.320.5918 MEI Dialysis Decision Aid Patient Questionnaire
Next Steps New Shift: Home Dialysis Referral Facility Kickoff Webinar Plan-Do-Study-Act Cycle (PDSA Cycle) Rapid Cycle Improvement Root Cause Analysis (RCA) MEI Decision Aid New Shift Readiness Sustainability Action Plan Data Collection Disparities in ESRD
Next Steps SUBMIT FEBRUARY 1-28 HOME DIALYSIS REFERRAL DATA NO LATER THAN WEDNESDAY, MARCH 1 TEST MEI DIALYSIS DECISION AID ON THE STAFF-LEVEL AND SUMBIT THE FEEDBACK FORM NO LATER THAN FRIDAY, FEBRUARY 24 USE THE PDSA WORKSHEET TO DEVELOP A PLAN TO DISSEMINATE/ADMINISTER THE MEI DIALYSIS DECISION AID TO AT LEAST 8 PATIENTS. SUBMIT THE PLAN NO LATER THAN FRIDAY, MARCH 3 RETURN COMPLETED PATIENT QUESTIONNAIRES NO LATER THAN TUESDAY, MARCH 14 REGISTER AND BE PRESENT FOR THE 3/17 WEBINAR UPDATE PERSONNEL IN CROWNWEB
Questions? Andrea Moore amoore@nw5.esrd.net 804.320.0004 ext. 2714 804.320.5918