Transcript Facility characteristics

Dialysis Facility Compare (DFC)
Website Evaluation
ESRD Stakeholders Meeting
March 25, 2004
Michael Trisolini, PhD, MBA
RTI International
Presentation outline
1. Project Overview
2. Website Presentation & Navigation
3. Facility Characterisics
4. Quality Measures
5. Dialysis and Kidney Disease
Information & Links
6. Next Steps
1. Project overview
Personnel
CMS Project Officer
Eileen Zerhusen, RN, BSN
DFC Evaluation Project Staff
RTI
Michael Trisolini, PhD, MBA
Amy Roussel, PhD
Shelly Harris, MPH
Karen Bandel, MPH
Philip Salib, BA
MEI
Dorian Schatell, MS
Kristi Klicko, BS
Project timetable
Sept. 2002 – Nov. 2002 - Planning, recruiting participants
Dec. 2002 – June 2003 - Qualitative data collection with 6
types of respondents
July 2003 – Oct. 2003 - Reports and recommendations, begin
mock-ups of revised DFC
Nov. 2003 – Nov. 2004 - Develop and test mock-ups of revised
DFC, develop new content
General objectives

Gain feedback on current DFC content and features
from patients, family members, and professionals

Investigate current patterns of DFC use

Study information needs of potential DFC users

Identify ways to improve the DFC
Qualitative data collection

Focus groups

Triads (small focus groups)

In-person interviews

Telephone interviews
Locations for data collection

Site visits (about 1 week each)





Washington, DC
Atlanta
Chicago
Phoenix
Telephone interviews
Respondent types
Number

Dialysis patients & family members
98

Dialysis professionals & technicians
98

Pre-ESRD (CKD) patients & family members
42

Pre-ESRD professionals

Senior staff of dialysis chains, MCOs & DMOs

Senior staff of national renal organizations
8
18
6
Dialysis patients & family
Number

Hemodialysis patients
63

Peritoneal dialysis patients
12

Family Members
23
---98
TOTAL
Dialysis professionals & techs
Number

Nephrologists
9

Nurses
22

Social workers
29

Dietitians
25

Technicians

Renal administrators
9
TOTAL
4
---98
General findings - 1

Few respondents currently using the DFC

HD & pre-ESRD patients pleased to have access to the
data on DFC, saw it as relevant, but wanted more data
and more user-friendliness

Dialysis family members & PD patients less satisfied

All respondents had many ideas for improvements to
DFC
General findings - 2

Dialysis patients perceived to have less choice among
facilites when starting, but more later

Variation by site

Pre-ESRD patients & family have many learning needs

Pre-ESRD educational programs are in early stages of
development
General findings - 3

Internet access less of a problem than expected

Public reporting of quality data perceived by
professionals to have value for quality improvement

MCOs & DMOs saw applications for DFC

CMS perceived as honest broker for dialysis &
facility information
RTI Recommendations

Based on findings from research

Currently proposals being evaluated by
CMS staff

Implementation now under consideration
2. Website presentation &
navigation
Readability

Aim for 5th grade reading level

Settle for 7th – 9th grade reading level

Provide button to increase font size
Reduce density of text

Break long text sections into manageable pieces
- “chunking”

Short sentences & paragraphs

Bulleted lists

Columns to limit line length to 30-50
characters

Subheadings
Example – current DFC

Read This: The information in Dialysis Facility
Compare should be looked at carefully. Use it with
the other information you gather about dialysis
facilities as you decide where to get dialysis. You
should visit any facility in which you are interested
and talk with the dialysis facility staff. You may also
want to contact your doctor, local ESRD Network or
State Survey Agency for more information before you
choose a dialysis facility. The telephone number for
the local ESRD Network and State Survey Agency
can be found in the Helpful Contacts section of this
website.
Revised DFC Mockup
Spanish

Create a Spanish language version of DFC

Use model from Nursing Home Compare

“Vea en Espanol” button on each page in English

“View in English” button on each page in Spanish
Increase non-text content

Graphics, photographs, diagrams, cartoons

Mapping function with “zoom” (like MapQuest)

Animation

Audio clips, video clips
Revised DFC Mockup
Concerns with non-text content

Section 508 – accessibility for visually impaired
beneficiaries

Load time

Hardware, software requirements
Reduce scrolling

Add headings with hyperlinks

Add tabs and sub-tabs for results
Revised DFC Mockup
Add user-friendly features for
those with little web experience


Tabs or hyperlinks for special populations

PD patients

Family members

CKD patients

Pediatric patients and their parents
Clarify context, “why to use DFC”
Revised DFC Mockup
Facility characteristics table

Enable facility characteristics table to show 4-6
facilities per screen versus 2

Reduce font size if needed, with option to switch
back to larger font and 2 facilities per screen
3. Facility Characteristics
Current DFC
Participants suggested many
new facility characteristics

Patient issues

Staffing issues

Organizational issues

Policy issues
PD patients have special
information needs

Number of PD staff

Number of PD patients

PD patients per PD nurse

PD training

PD supplies and equipment
Pre-ESRD patients and family
made fewer suggestions

Don’t know enough to know what they need to know

Very interested in the experience of receiving dialysis
care

Patient checklists would be very helpful
Add patient checklists

DFC cannot offer everything

Encourage patients to contact dialysis facilities and
providers with specific questions

Provide detailed list of potential areas of inquiry
Consider facility characteristics
from SIMS database

Review available data elements

Add relevant facility characteristics
Consider information on state
surveys and inspections

Follows Nursing Home Compare (CMS
exploring similar approach for DFC)

Most recent Medicare certification (initial
certification date already posted on DFC)

Most recent state survey date

Deficiencies cited

Add to checklist
Information on amenities


Topics highlighted by respondents:

Support groups

Visitor policy

Accessibility for people with disabilities

Televisions

Data ports

Cleanliness
Add to checklist
Information on scheduling

Shift times

Hours and days of operation

Add to checklist
Offer more information about
modalities

Availability

How many patients are receiving
various modalities

Add to checklist
Staffing information

Staffing ratios

Certification or training of technicians

Number staff on site

Clinical staff availability

Add to checklist
Revised DFC Mockup
3. Quality measures
3. Quality measures
Adequacy & Anemia
Presentation – very appealing

Colored bar graphs

Comparisons to national & state averages

Multiple facility comparisons
Content

Patients & family members liked comparing facilities

Kt/V & hemoglobin preferred by professionals

But URR & hematocrit considered acceptable

Professionals had some casemix concerns

Age of the quality data was not a major concern for
patients & family members, but was for professionals
Text explanations – problematic

Glossary definitions too complicated, too long

Explanations above the bar graphs better, but not great

Reading level too high

Too much text – patients & family usually skip over it
3. Quality measures
Patient survival
Patients & family

Statistical language hard to understand – “better than
expected”

Explanation above the results table unclear to many

FAQs better

Most prefer bar graphs (adequacy & anemia) to the
check marks in the patient survival results table

Most still wanted to see survival data
Professionals

Concern that non-facility factors affect survival
 Percent elderly & nursing home residents
 Percent poor nutrition or non-compliant
 Percent comorbidities

Some understood existing casemix adjustments
(age, race, gender, diabetes) but many missed it

Also liked FAQs

Suggested text explanations too complex for
patients & family
3. Quality measures
Recommendations
General

Add (a few) more quality measures

Consider PD-specific quality measures

Replace “Not Available” with specific reasons
Current DFC
Revised DFC Mockup
Presentation


Revise text explanations

Reduce amount of text

Highlight links to FAQs & expand them

Lower reading level

More use of non-text methods – diagrams,
pictures, graphics
Consider presenting quality data as trends over
time
Recommendations for new
measures - 1

Patient satisfaction (experience of care)

STRONG preference of patients (they want to
hear from other patients)

A way to have their “voice” heard

Also supported by professionals

Most dialysis facilities already collect these data
Recommendations for new
measures - 2

Transplant waiting list

Vascular access

State survey results
Recommendations for new
measures - PD

PD-only adequacy (Kt/V)

Albumin levels
Recommendations for changing
measures

Kt/V versus URR

Hemoglobin versus hematocrit

Follow Clinical Performance Measures

Most facilities already collect these data
5. Dialysis and kidney disease
information & links
Uses of DFC for patient
education

Patients would like more information on a
range of topics

Professionals saw potential for use in
educating patients

CKD educators could add to their resource
lists and classroom exercises

Currently limited applicability to PD patients
Additional information sought - 1

Patient experience of treatment. E.g., “What’s it
like to be on PD?”

Information on clinical aspects of dialysis &
renal disease

Information on dialysis and CKD self-care (e.g.,
nutrition, vascular access)
Additional information sought - 2

More on transplantation

More on PD

Explanations of medical terms (e.g., “necrotic”)

Meaning of lab results – link to quality measures

Implications of patient non-adherence to treatment

Rights and responsibilities of patients
Develop checklists for patients

Reinforce message that patients should seek
information from facilities and providers
directly

Patients often don’t know what to ask

Support patient involvement in decisionmaking and in managing their own care
Make Web links more
prominent and more extensive

Other federal and state resources

Renal organizations

External information sources

Patient education resources
Consider special needs of new
dialysis and CKD patients

Would like better understanding of kidney
function and renal disease

Adjusting to dietary changes

Facing choices:

how to delay need for dialysis

vascular access

dialysis modality

transplant

dialysis facility
Consider information needs of
other special populations

PD patients

Family members

Pediatric patients & their parents

Non-English-speaking patients
6. Next Steps
To provide input

Eileen Zerhusen, CMS


[email protected]
Michael Trisolini, RTI

[email protected]
Questions & comments

Comment form in conference
notebooks

Microphones in aisles
RTI Next Steps

Assist development of Next Generation
DFC

Test new language and text

Develop and test checklists

Plan additional revisions to DFC
CMS Next Steps

Consider additional quality
measures for public reporting