Transcript Document

NEW YORK CKD
COALITION
Enhancing CKD System Changes through
Collaboration in New York State
November 2008
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IPRO

Medicare Quality Improvement Organization for New
York State (NYS).
End Stage Renal Disease Network for NYS (ESRD
Network 2).
One of the 10 states awarded the CMS 9th SoW Chronic
Kidney Disease (CKD) Project – Theme 7.3.
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Background
New York
ranks 4th in the
incidence of
CKD
9th
leading
cause of death
in the U.S.
For each patient
who does not
progress to dialysis,
Medicare saves
$250,000.
Nearly 26 million American
have CKD, with 1.2 million
in NYS estimated additional
20 million undiagnosed
CKD beneficiaries are living
with CKD and don’t know it.
Screening rates
for patients with
known risk
factors for CKD
are as low as
20%. Currently
42% in NYS.
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Background
Screening rates for patients with known risk factors for
CKD are as low as 20%. NYS currently at 42%.
Hypertensive diabetics, treated with ACEs, the
progression of CKD can be slowed.
The fistula rate for NYS is 55.3%. The Fistula First
Breakthrough Initiative (FFBI) goals are to increase the
rate to 55% (already achieved) by 3/31/09 and 66% by
6/30/09.
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Mission Statement
Encourage the early identification and
treatment of CKD and minimize and/or
prevent the onset of ESRD in
New York State.
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CMS CKD Quality
Improvement Goals
Early detection and decrease the progression of CKD.
 Improve statewide rate timely testing for diabetes – annual micro
albumin testing.
 Improve statewide rate of prescribing ACE/ARBs – slowing
progression – hypertensive individuals with diabetes.
 PQRI companion measure.
Key collaboration with NYS-CKD Task Force for system
changes at state and local level.
Improvement of Fistula placement rate at onset of
hemodialysis.
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Why Support IPRO’s
CMS NYS Collaborative???
NYS CKD Quality
Improvement
Opportunity
Medicare Cost CKD
Medicare
Sav ings - CKD
NYS-CKD
IMPACT
Improv e Quality
of Care for
Medicare
Beneficiaries
through CKD
Project for New
York State
Cost to
Medicare of
managing CKD
is high.
Medicare
beneficiaries
with CKD
account for
16.5% costs in
the year the
disease is
identified
Sav ings to
Medicare for
each patient
who does not
progress to
dialysis is
estimated at
$250,000
Increasing
incidence
affecting elderly
and disparity
populations
with high
correlation to
DM & HTN
conditions with
escalating cost.
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New York State Impact

1.2 Million (est.) New Yorkers
affected by CKD.
CDC reports a 116% increase
in CKD in NYS over the past
decade.
NYS 4th highest state at $2.9
billion.
13.1% of NYSCKD patients are
65 or older.
43% of hospitalized CKD
patients are diabetics.
Diabetic CKD prevalence rate
increasing from 6.2% to 7.6%
(2000-2006) in NYS.
African-American and
Hispanic-Americans have
higher rates of CKD.
African Americans represent
17.4% of NYS population, yet
were 40.3% of prevalent CKD
cases in 2006.
7,300 New Yorkers will
advance to ESRD annually.
Primary Causes of ESRD
 Diabetes 40.5%
 Hypertension 24%
23,000 New Yorkers suffer
from ESRD with almost 5,000
deaths annually.
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Challenges
PCP Support- Time Allocation, Recruitment and Education
Perceived high rate of prescribing of ACE/ARBs for
Medicare Beneficiaries
Uninsured ESRD Patient waits for 3 months to qualify for
Medicare
Graft Surgery is better reimbursed than AVF
Physicians creating more AVF get lower income due to
lower intervention needs
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Strategy
Physicians
Annual micro-albumin testing.
Prescription of ACE/ARBs for diabetic patients.
Referral of patients to nephrologists for fistula counseling where appropriate.
Support PCP CKD education.
Support EHR where appropriate.
University Model
Adoption of processes that target CKD patients for community outreach to implement a chronic care model.
Continuum of care model for improved communication among PCPs, specialists and patients.
Support EHR where appropriate.
CKD Coalition
Identification of priorities at the system level and development of recommendations that can be
implemented in all settings.
Increased public awareness and professional education of CKD management.
Advocate and promote policy and system level changes affecting CKD.
Community Outreach/ Community Health Centers
CKD Education outreach.
Support CKD Screening.
Support renal community communication of CKD.
Pharmacy Model
Prescription review with PCP recommendations.
Pharmacy school clinical education extension process.
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Goal: System-level Change
Considered a change in:
● Practice
● Policy, or
● Procedure
Results in sustained improvement
Influenced by activities
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High Functioning Coalition
Information
Sharing
Leveraged
and
contributed
resources
Focused,
common
mission with
tangible,
attainable
goals.
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Goals for IPRO’s
NYS-CKD Coalition
Assist in increasing adoption of evidence-based practice
standards.
Promote community awareness through education.
Support and promote IPRO’s efforts to effect system level
improvement.
Collaboration of Membership for NYS CKD
● Task force to drive public awareness of CKD
● Promote evidence based Chronic Care Model
● Collaboration with other interested entities in the care and treatment of
renal disease
● Promote community screening, e.g. NKF KEEP Program
● Support efforts of the ESRD Network, e.g. Fistula First
● PCP education
● Participation in CKD workgroups to affect system level changes
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Mission of NYS CKD Coalition

To combine the efforts and resources of members and
encourage prevention, early detection and appropriate
ongoing treatment of CKD;

To communicate Kidney Disease Outcomes Quality Initiative
(K/DOQI) standards of care to health care providers, annual
micro-albumin test, prescribing ACEs or ARBs, referring
patients to nephrologists, and encouraging AV fistula
placement and maturation.

Communication and support of American Diabetes
Association Standards of Medical Care in Diabetes –2008.
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Blueprint for Action

A shared vision.

A set of common principles, strategies, and
actions for achieving goals.

A broad, collaborative and transparent
process led by and involving diverse
stakeholders.
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Blueprint for Action
Key focus areas
 Outreach and education
 Care delivery
 System-level changes
 Resources
The Blueprint is not the end, but the
beginning.
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NYS CKD Coalition –
Action Steps
 Promote and support early screening for CKD through
existing programs, e.g. NKF KEEP.
 Communicate and educate care community- ADA
Standards of Medical Care in Diabetes –2008 .
Promote and support chronic care model for CKD.
 Promote and support continuum of care communication
(University Model) where applicable.
 Promote and support PCP model.
 Promote and support pharmacy model of ACE/ARB
improvement.
Promote and support EHR where appropriate.
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NYS CKD Action Steps
To encourage and facilitate dialogue to:
 increase understanding and action of community health
priorities (specifically CKD & ESRD)
 facilitate removal of barriers to improving the health status of
the community;
To disseminate provider and patient educational
materials for achieving the CKD coalition objectives.
Support existing activities in the CKD community, e.g.
NKF KEEP, North Shore University CKD Program.
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NYS CKD Action Steps
To share knowledge and best practices
with other organizations to better serve
their populations.
Ultimately, the coalition’s combined
disciplines, strengths and resources will
educate, motivate, and improve outcomes
for Medicare beneficiaries and other
healthcare consumers.
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NYS CKD Coalition
Membership
Broad-based membership with representation from providers,
patients, regulators, educators, community health care
organizations and the renal communities.
Leadership & Coordination
 NYS CKD Task Force
 IPRO-CKD Coalition
Meetings
 Regular teleconferences monthly
 Face-to-face twice per year
 Regular workgroup interaction
No fees or membership dues
Voluntary, not mandatory
Shared incentives and commitment to a working consensus
model
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Proposed IPRO-CKD
Coalition Members
Albany College of Pharmacy & Health
Sciences
Columbia University Nephrology Division
Albany County DOH
ESRD Network 2
Albany Dialysis Center
Albany Medical College
ESRD Network 2 Fistula First Steering
Committee
Albany Memorial Hospital- Laboratory Director
Feed the Soul Nutrition
American Access Care
Greater Brooklyn Health Coalition & CAMBA
American College of Clinical Pharmacy – NY
Chapter
Glen Falls Hospital dialysis Unit
American Diabetes Association-the Diabetes
Resource Coalition
IPRO Consumer Health Collaborative
American Nephrology Nurses Association- NY
Chapter
Lani Jones, Albany EDU
Blue Cross/Blue Shield of NY
Catholic Charities-Terrance Cardinal Cooke
Center
Columbia University College of Physicians &
Surgeons-Internal Medicine Residency Program
Counsel of Renal Social Workers
IPRO C. Bradley, MD
Dr. Kessel, Montifore Medical Center
National Association of Nephrology
Technicians
National Kidney Foundation- Dr. Joseph
Vassalotti
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Proposed IPRO-CKD
Coalition Members (continued)
National Kidney Foundation Kidney Early
Evolution Program
NYS Senate Health Committee
National Kidney Foundation NY Chapters
NYSDOH Clinical Chemistry & Hematology
Laboratory Wadsworth Ctr.
National Kidney Foundation of NE NY
NYSDOH Heart Health Program
National Kidney Foundation of Central NY
Olean General Hospital
Nephrology Associates of Syracuse
Quentin Medical Labs
NY Chapter of the American Society of
Consultant Pharmacists
Renal Support Network
The New York State Council of Health-system
Pharmacists
New York Diabetes Coalition
North Shore LIJ Health System - Janet & John
Raggio Nephrology Institute
NYS CKD Task Force
NYS DOH Diabetes Prevention and control
Program.
NYS clinical Laboratory Association
Counsel of Renal Nutrition – Long Island
Chapter
State University of NY-Eli Friedman, MD
University of Buffalo Jefferson Family
Medicine. Chester Fox, MD
University of Buffalo, School of Pharmacy
Wegman’s School of Pharmacy
Chain of Pharmacy Association of NYS
Touro College of Pharmacy
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NYS CKD Coalition Structure
NYS CKD Task Force
Chair
IPRO CKD CQI Project
NYS DOH Diabetes Presenation &
Control Program
Vice Chair
Clinical Champions
NYS DOH Bureau of Chronic
Disease Services
Secretary
PCP Program
NYS Regulators & NYS Legislative
Marketing & Communications
Workgroup
System Level Changes
Workgroup
Clinical Practice Workgroup
Community Education Workgroup
University Program
Pharmacy Program
Renal Community
Other Interested Parties
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Workgroup Functions
Marketing &
Communications
Workgroup
System level
changes
Workgroup
Clinical Practice
Workgroup
Community
Education
Workgroup
Develop/identify audience
appropriate message
Identify change
opportunities for coalition
and their implementation
Promote adoption of
K/DOQI clinical guidelines
with PCP Practices
Create a listing of
beneficiary education
materials
Interact with other groups
to define target audiences
for out reach and
distribution of coalition
products and marketing
packets
Options for achieving
change
Promote positive clinical
treatment patterns and
best practice through peerto-peer contact, education
and training
Evaluate materials using
Clinical Champions
Develop directory of New
York State nephrologists
Analyze options for
change and there
feasibility
Promote ADA care
guidelines
Develop / adopt core
messages for patients
Coordinate speakers
bureau and assist with
other marketing activities
Outline implementation
steps for recommended
changes
Promotion of Continuum of
Care-Chronic Care Model
(University Model)
Develop dissemination
plan for community
education
PCP recruitment
Develop statewide policy
& regulatory improvement
Promotion of Pharmacy
Model
Develop dissemination
plan for provider
education
Develop data for CKD and
its impact in NYS
Support CKD research
Distribute CMS-CQI results
for NYS and national
benchmarks
Support CKD patients
needs and activities
Develop list of provider
participants.
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Next Steps
Organizational meeting
 ____________, 2008 – Teleconference
 Facilitated by IPRO
● IPRO’s role
● Coalition structure
● Volunteer workgroup established
● Meeting dates
● Blueprint for Action
● Next meeting
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For more information, contact
William F. Brezsnyak, MHSA
Project Director
(516) 209-5356
[email protected]
Jessica Squeglia, BA
Performance Improvement Coordinator
(516) 209-5234
[email protected]
Chris Scalamandre, BS, RD
Performance Improvement Coordinator
(516) 209-5248
[email protected]
Clare Bradley, MD
Medical Director
[email protected]
Ti-Kuang Lee, ScM
Statistician
[email protected]
Alan Silver, MD
Clinical Director
[email protected]
Thomas Hartman, BA
Vice President
[email protected]
Susan Ulmer, BA
Administrative Assistant
[email protected]
Corporate Headquarters: 1979 Marcus Avenue, Lake Success, NY 11042 ● www.ipro.org
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