Key Performance Indicators

Regional Nephrology System (RNS) Chronic Disease Prevention and Management Key Performance Indicators 8/9 Fiscal Year End Report Version: 1. Date published: April 7th, 9 Created by: Ethel Doyle: RNS Interim Director & Emily Harrison: CDPM Project Manager 1

Key Performance Indicators The Key Performance Indicators (KPIs) listed in this document are the primary performance indicators selected by the CDPM RNS team. These KPIs are likely to change or be revised over time as our abilities to collect data becomes more automated. The KPIs are meant to provide measurements that reflect the critical success factors of this RNS CDPM program. Overview The RNS CDPM KPIs align with the RNS Quality Framework. Measures under each of the 3 key components: Business, Operations, and Clinical Outcomes are reported to measure and track critical performance variables over time and provide a statistical measure of how well this program is doing in each of the 3 components of the RNS Quality Framework. Operations Activity Volumes & Resources Volume of patients by service area Outcomes Trends volumes by service area Percentage of Home Dialysis to In-Centre Hemodialysis (ICHD) Provincial target is Home Dialysis : ICHD ratio Total # of RNS KCC Cases Trends growth within the Kidney Care Clinic (KCC) Percentage of Home Dialysis: ICHD patient starts from Kidney Care Clinic Total # of RNS patients seen in hospital (by service area) Provincial target is 5% of new dialysis starts from KCC will start home dialysis. Total ER Visits (by service area) Total Admissions (by service area) Clinical Performance Clinical Outcomes for RNS patients Anemia: Percentage of RNS patients (by service area) in and out of target range. Blood Pressure Percentage of RNS patients (by service area) in and out of target range. Nutrition Percentage of RNS patients (by service area) in and out of target range. Dialysis Adequacy Percentage of RNS patients with PRUs < 65% Infection Rates Prevalence rates of Catheter Associated Blood Stream Infection and Peritonitis rates Amputations Estimated prevalence of RNS patient amputations and associated costs Outcomes Goal/Target for program yet to be determined. Currently benchmarked against the Ontario Monitor data Measure Albumin, A1C, and SGA Goal/Target for program yet to be determined. Benchmarked against established standards. Demonstrated cost savings associated with improved amputation outcomes Business (Financial metrics) RNS Budget Cost savings resulting from CDPM project initiatives. Outcomes Measures the estimated cost savings resulting from some operational and clinical performance outcomes resulting from the CDPM project initiatives.

CE LHIN RENAL CDPM PERFORMANCE INDICATOR REPORT 8/9 Fiscal Year End Report Reporting on the three key elements that compose the RNS Renal Quality Framework: Business, Operations, and Clinical Outcomes, this Renal CDPM Indicator report is intended to outline key performance indicators that measure the impact the Renal CDPM program has on care delivery outcomes. Operational Outcomes % ICHD to Home Dialysis 1st-4th Quarter 8/9 1% YTD # of patients by service area -Q4 8-9 8% 38% 39% 39% 7 6 5 MoH Tar get : Home: ICHD 4 3 6% 61% 61% 1 % Total Dialysis Incentre HD CCPD CAPD Total PD HHD KCC % Apr i l May June Jul y Aug Sept Oct Nov Dec Jan Feb Mar Aver age Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar ICHD Total Home Dialysis Kidney Care Clinic Cases Total Dialysis Incentre HD CCPD CAPD Total PD HHD KCC Apr 377 35 78 35 113 9 595 May 359 17 8 33 113 9 569 June 36 16 8 35 115 9 56 July 359 16 8 35 115 8 556 Aug 364 18 83 33 116 3 579 Sept 368 81 33 114 3 576 Oct 359 15 79 33 11 3 578 Nov 36 19 76 33 19 3 594 Dec 36 17 78 33 111 3 593 Jan 367 78 37 115 3 59 Feb 364 77 35 11 3 581 Mar 364 74 35 19 33 585 7 6 5 4 3 1 57 585 55 485 43 345 74 19 1/ /3 3/4 4/5 5/6 6/7 7/8 8/9 Fiscal Year % Home Dialysis :ICHD Patient Starts from KCC 1% 9% 8% % % Provincial Target: 5% of KCC patients to start Home Dialysis 5% 38% 3% 9% 14% 35% 5 Total # of RNS patients seen in hospital (Admissions & ER Visits) April/8-July/8 PD ICHD 7% 71% 1% 1% 67% 199 5% 3% % 1% 3% 63% 33% 75% 7% 71% 86% 65% # pts 15 1 5 41 91 1 3 56 68 143 % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Avg Total pts seen Total Visits # Admissions # ER Visits %PD Starts from KCC % ICHD starts from KCC 3

Clinical Outcomes Anemia Blood Pressure Percentages 9% 8% 7% 5% 3% % 1% % 8% RNS Hg Targets -Q 8 % 1st Quarter (Apr-Jun/8) Quarters 78% % nd Quarter (Jul-Sep 8) In Target Out Target 9 8 7 6 5 4 3 1 79 7 6 63 Nondiabetic 59 48 44 8 Diabetic LHC PD Ontario LHC KCC LHC HHD Nutrition Dialysis Adequacy 1% 9% 8% 7% 5% 3% % 1% % Percent RNS Nutrition Quality Indicator Report 6-8() HD PD HHD KCC 6/7 7/8 8/9 () 6/7 7/8 8/9 () 6/7 7/8 8/9 () 5% % 15% 1% 5% % Patients with PRU (hemodialysis clearance) <65% Albumin-->35g A1C < 7% SGA >5 1st Q nd Q 3rd Q 4t h Q Albumin-->35g A1C < 7% SGA >5 Program 6/7 7/8 8/9 () 6/7 7/8 8/9 () 6/7 7/8 8/9 () HD 7% 7% 64% 74% 7% 74% 9% 95% PD 75% 7% 69% 45% 44% 43% 84% 9% HHD 87% 9% 67% 78% 1% KCC 85% 86% 87% 71% 7% 7% Infections 1.6 1.4 1. Catheter Associated Blood Stream Infection Rate 5/ 6-8 /9 8 6 # of Months between episodes of peritonitis 1..8.6.4. - 5/6 Q Q4 6/7 Q Q4 7/8 Q Q4 8/9 Q Q 3 Q4 4 4/'5 5/'6 6/'7 7/'8 8/'9 #C ABS I/1 line day s b enc hmark # of month betw een episodes of peritonitis Other Approximate # of RNS patient amputations April 6-April 8 1 Total # of amputations 1 8 6 4 April 5 - April 6 Apri. 6 - April 7 April 7 - April 8 Date Approximate # of RNS patient amputations 4

Business (financial) Outcomes Cost efficiencies relative to # of peritonitis cases Total cost savings attributed to achieving current CABSI rate $16, $14, $1, $1, $8, $6, $4, $, $ Cost efficiencies= $8,734 $51,16 Total Peritonitis costs at 1:54 $133,95 68 Total Peritonitis costs at 1: 6 # Cases at 1:54 (Current) # Cases at 1: 7 6 5 4 3 1 $45, $4, $35, $3, $5, $, $15, $1, $5, $ Cost efficiencies= $7,13 $13,67 Cost at.4 episodes/ 1 line days $4,8 4 Cost at 1.4 Total cases at.4 episodes/ episodes/ 1 line days 1 line days (RNS Achieved rate) 7 Total cases at 1.4 episodes/ 1 line days (Standard rate) 8 7 6 5 4 3 1 Total Costs Episodes per 1 line days Costs associated with ICHD: Home ratio and % dialysis growth Total costs associated with amputation cases $5,, $4,5, $4,, $3,5, $3,, $,5, $,, $1,5, $1,, $5, $ 6:4 &.7% (Current state) $1,7, 6:4 & 6% Cost savings 6:4 &.7% (Current state) $,97, 8: & 6% Cost savings $, $18, $16, $14, $1, $1, $8, $6, $4, $, $ 1 cases Approx. cost per case= $17,5 cases cases 5/6 6/7 7/8 cost Time saved with improved process of providing diet educational material Cost savings associated with time saved with improved process of providing diet education matierial Minutes 6 5 4 3 1 Current time 35 minutes saved per patient Improved time $5, $4, $3, $, $1, $ Current time Approx. $9K cost savings Improved time Total Minutes per patient Total Costs (@1 pts) Total estimated CDPM cost savings resulting from implemented CDPM initaitives $,,. $1,8,. $1,6,. $1,4,. $1,,. $1,,. $8,. $6,. $4,. $,. $. Total estimated cost savings $1,961,946.9 $8,733.78 $7,13.1 $14,. Peritonitis CABSI amputation cost CDPM Initiatives $1,71,. move to home (current 6:4 and.7% grow th) 5

Objectives: Slow progression of CKD patients on to dialysis To promote growth of home dialysis Decrease wait times for dialysis access procedures (indicator measurement to be added at a future date) Reduce the number of RNS patient ER visits & in hospital admissions Reduce acute care in-patient services rate Reduce emergency services rate/costs (baseline established; KCC and HHD measures outstanding) Meet best practice clinical standards (as measured by the clinical outcome indicators) Accomplishments/Summary of Outcomes: Continuing to maintain the : mandated MoH split of Home Dialysis: ICHD modalities Surpassing the recommended best practice standard that 5% of KCC patients should be started on a home dialysis modality (as per the MoH Provincial PD Initiative). Growth in KCC and the educational, counseling, and self management support provided to patients in this area, contributes to the slowing of CKD progression and to the overall growth in the number of patients starting dialysis. Baseline for ER and Hospital admission established. Continue to facilitate the process of regular reports of this indicator and are working to include data for HHD and KCC patients. Hope to demonstrate a decrease in ER and Hospital admissions in the RNS population. Following best practice and evidence based guidelines i.e. Diabetes, Cardiovascular Disease, and Kidney Disease Management decreases morbidity and mortality within this patient population. Maintaining health and improving clinical outcomes decreases health care costs. Significant cost savings have been demonstrated with implementation of a few of the current implemented CDPM initiatives and improvement practices. A total of $1.96M (conservative estimate) has been calculated as a system cost saving resulting from CDPM practices. Next Steps: The following are other indicators/measures to be reported as soon as the RNS has access to the data required to calculate the following: o Acute Care in-patient services costs o Per patient and total dialysis access cost from CKD/KCC and ESRD o Average wait time for dialysis access procedures from CKD/KCC and ESRD o Patient Quality of Life (QOL) outcomes o Patient/Staff satisfaction o KCC patients by CKD stage 6