Transcript ESRD NETWORK OF NEW ENGLAND (Network 1)

Network of New England
“An Educational Day &
Time Out For Technicians”
April 24, 2008
Douglas Shemin, MD
Network Chairman
ESRD Network Organization
• ESRD Medicare Program Public Law 92-603 in 1972.
• Medicare coverage for ESRD began July 1973.
• ESRD Network Coordinating Councils (32 areas)
established in 1978, consolidated to 18 networks in 1988.
• Network Organizations are independent contractors.
Performance evaluated by CMS annually. 2/18 networks
now administered by QIOs
• Contracts renewed every 3 years based on performance.
• Network of New England, Inc. (not-for-profit
corporation) has held the ESRD Network contract for 30
years.
• New contract effective July 1, 2006 for three years.
ESRD Network Organization
• Each network has paid staff, volunteer Board of
Directors (BOD), volunteer Medical Review
Board (MRB). The MRB reviews, suggests QI
projects, reviews grievances and complaints),
and patient advisory committee.
• BOD and MRB made up of nephrologists,
nurses, dieticians, social workers, administrators,
transplant professionals, patient representatives
and technicians.
• Network of New England welcomes interested
renal professionals to our BOD and MRB.
What do the Networks do?
• Collect data (demographics, comorbidity, mortality
information) on > 400,000 patients in > 4000 facilities
• Assess Data: Identify QI needs on a local level, institute
and administer QI projects, offer assistance to
underperforming facilities
• Respond to grievances, complaints, concerns by patients,
families, and facilities.
• Special projects
New England
Provider
Distribution
Number of ESRD Providers: 2001 & 2006
ESRD Resources in New England 12/31/2001
ESRD Resources in New England 12/31/2006
Modality By State: 2001 & 2006
2001 Dialysis Prevalence by Modality: Provider of Service
2006 Dialysis Prevalence by Modality: Provider of Service
Dialysis Patient Characteristics in New England
Dialysis Population 12/31/2006
New England Population by Race
Age and Gender of the Dialysis Population
Female
Male
Dialysis Pts.
60%
All Residents
100%
Percentage of Patients
87%
76%
50%
80%
40%
36%
32%
38%
34%
60%
30%
20%
40%
18%17%
13%13%
20%
10%
20%
5%
0%
0-44
45-64
65-79
Age Groups
4%
8%
0%
>= 80
Black
White
Other
Etiology of Dialysis Population
Black
White
Other
60%
50%
40%
41%
39%
40%
25%
30%
20%
22%
27%
16%
15%
20%
13%
19%
23%
10%
0%
Diabetic
Hypertension
Glomerulonephritis
Other/Unknown
From Network 1 Annual Report 2006: in New England,
27% working age dialysis patients work, 3% go to school
patients
CT
MA
RI
VT
NH
ME
Total
18-54
3,389 962
5,091 1,334
880
208
291
57
731
194
958
228
11,340 2,983
Employed
school
277
351
45
5
53
64
795
23
52
5
1
4
4
89
Providers with Treatments after 5PM
2001
# Dialysis
Providers
2006
# Providers w/
shift after 5PM
# Dialysis
Providers
# Providers w/
shift after 5PM
CT
32
7
22%
31
9
29%
MA
67
26 39%
74
26
35%
ME
13
6
46%
18
5
28%
NH
10
6
60%
10
5
50%
RI
14
2
14%
18
2
11%
VT
6
4
80%
7
6
86%
Total
142
158
53
34%
51 36%
Dialysis Providers by Ownership
12/31/2006
CT
MA
ME
NH
RI
VT
Total
Percent
For profit
chain
Hospital
Independent,
nonprofit
Total
26
51
10
9
15
0
111
70%
5
23
8
1
3
7
47
30%
31
74
18
10
18
7
158
100%
CMS / CPM Data
Target
Indicator
2006
National
Report
8,609
Patients
2007
National
Report
8,740
Patients
Network
2006
National
Report
471
Patients
Network
2007
National
Report
484
Patients
CMS
Network
Mean URR % > 65
80%
90%*
88%
88%
90 %
91%
Mean KT/V > 1.2
84%
90%*
91%
90%
92 %
94%
Mean Hemoglobin
> 11 gm/dL (Anemia)
80 %
80%
84%
84%
85 %
84%
Mean Tsat % > 20%
80%
80%
78%
80%
76 %
81%
Mean Serum Ferritin %
> 100 ng/mL
80%
80%
95%
95%
96 %
95%
Prevalent Pts with Serum
Albumin > 4.0/3.7 gm/dL
BCG/BCP (Nutrition)
N/A
32%
33%
37%
32 %
35%
Prevalent Pts with Serum
Albumin > 3.5/3.2 gm/dL
BCG/BCP (Nutrition)
80%
80%
80%
82%
80 %
79%
Prevalent Pts with Catheter
> 90 days (Vascular Access)
10%
Reduce
3%/yr
21%
22%
20 %
20%
66% by
2009
> 54.6% by
3/08
44%
46%
51 %
57%
Prevalent Pts with AVF
*Goals adjusted by the BOD/MRB 6/07.
Source: CMS/CPM 2006/2007 report, which has 2005/2006 data.
+Serum Albumin is not considered a CPM.
Note: Annual random 5% patient sample
4 targets:
KT/V > 1.2, Hgb > 11, AVF, albumin > 4
• Rocco, Annals Internal Medicine, 2006
1 year death rate
4/4 targets
7%
3/4 targets
14 %
2/4 targets
21 %
1/4 targets
25 %
0/4 targets
29 %
Why “Fistula First”?
Better solute clearance with AV Fistulae
Much lower risk of infection: Sixfold greater
rate of bacteremia with catheters (Hosp Inf
Disease 2003)
Lower risk of death with AV Fistulae: (from
CHOICE Study, JASN 2007)—47 % higher
adjusted mortality rate in catheter patients
compared to AVF patients
Prevalent Vascular Access
Network # 1 and State
Jan. 2007 to Jan. 2008
2007 AVF
2008 AVF
2007 AVG
2008 AVG
Catheter 2007
Catheter 2008
70
60
50
40
30
20
10
0
NW1
RI
NH
ME
MA
CT
VT
Quality Improvement Initiatives
• Fistula First increase to 66% by 2009
• Clinical Performance Measures for focused intervention
– Anemia Management
• Network Special QI Projects
– Catheter reduction
– Nutrition management
– Patient Safety
• Facility Specific Quality Assessment and Performance
Improvement Projects
– Use data profiles to identify providers needing assistance
– Provide QI technical assistance to dialysis providers
5 Diamond Patient Safety
Program
ESRD Network of New England
(Network 1)
&
Mid-Atlantic Renal Coalition
(Network 5)
Patient Safety Culture
•
•
•
•
•
Pervasive Commitment to Patient Safety
Open Communication
Blame-free Environment
Safety Design
Employee & Physician Involvement &
Accountability
Objectives
• To promote patient safety values
• To create an awareness of patient safety issues
• To help dialysis units learn more about specific
areas of patient safety
• To build a patient safety culture in every dialysis
unit
Educational Modules
Patient Safety Principles (required)
•
•
•
•
Hand Washing
Flu Vaccination
Slips, Trips and Falls
Medication
Reconciliation
• Emergency
Preparedness
• Sharps Safety
• Decreasing Patient &
Provider Conflict
 Under Development
• Staff Adherence to Procedures
• Dialyzer Set-up Errors
Modules
• Each topic is a complete educational module
• Tools and resources are located on the Network
of New England website
• Required and optional activities
• PowerPoints for staff in-service presentations
• Posters for display
• Games and activities to engage patients
Recognition
All participants completing at least one
component or more will be recognized
1 – 4 Diamonds
• Acknowledged in Network Newsletter
• Listed on Network Website
Recognition - 5 Diamond
• Acknowledged in Network Newsletter
• Listed on Website
• Special recognition at Annual Network Council
Meeting
• 2 free passes to Annual Meeting
• $75.00 gift certificate for entertainment material
for patients
• Plaque to display in unit
Details
• Time frame
– Starts April 2008 in Network #1
– Launch project at Technician Meeting
April 24, 2008
– Mass Mailing to all Providers & Medical
Directors
• Requires registration to do the program and
submission of documentation when each
module is completed by dialysis provider
Promote
Please go back to your facility and
encourage your management to
participate in this educational safety
effort.
ESRD Community Information
& Clearinghouse/Resource
•
•
•
•
•
•
•
Promote patient, public, and professional education
Maintain a resource library of educational materials
Conduct workshops on quality of care concepts
Distribute a newsletter to dialysis and transplant facilities
Maintain Network website, with QI links
Establish partnership and collaborative activities
Major disaster coordination
Complaints/Grievances
• Assist patients, family or providers
• Provide consultation or investigation
Network Leadership: 3 Face to
Face Meetings per Year
• Board of Directors: 25 to max of 40 members.
Term of service is 2 years but can be renewed to a
max of 4 years.
• Medical Review Board: 15 to max of 20
members. Term of service is 2 years but can be
renewed to a max of 4 years.
• Election to be held in November 2007. Terms
begin January 2008.
• 1/3 of BOD and MRB rotate off at each election
cycle.
CMS Conditions of Coverage for ESRD
Facilities Final Rule Published 4/15/08
Highlights of Provisions in the Final Rule Include:
• Updated CDC guidelines for hemodialysis
facilities
• Updated AAMI water quality guidelines
• Defibrillators in every dialysis unit
• Incorporates sections of the 2000 Life Safety Code
for fire safety
• Option for patients to have an advance directive
Highlights of Provisions in the Final Rule
Continued:
• Facilities provide written notice 30 days before a
patient is involuntary discharged
• Facilities perform clinical assessment within 30 days,
or 13 hemodialysis treatments, of patient starting
treatment
• Home dialysis water purity requirements based on
updated AAMI standards
• Facility-level quality assurance and performance
improvement program
Highlights of Provisions in the Final Rule
Continued:
• Minimum qualifications and training
requirements for patient care technicians (PCTs)
• Responsibility of Medical Director for Quality
Assessment and Performance Improvement
(QAPI) and involuntary transfers or discharges
• Electronic data collection and reporting
The CMS link to the final rule:
www.cms.hhs.gov/CFCsAndCoPs/downloads/ESRDdisplayfinalrule.pdf
Effective Dates
Life Safety Code and Separate
room for HBsAg+ patients
6 months
10/14/2008
300 days
2/9/2009
Certification of technicians hired
after 10/4/2008
18 months from
hire
Certification of existing technicians
24 months
4/15/2010
New Conditions for Coverage
Governance: Electronic Data Submission
As of 2/1/2009, every facility must electronically submit data on all
patients, including data on clinical performance measures, to CMS.
Thank you for all the
good work you do for
your patients