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Network 11 Quality Update

Network 11 Quality Update. Chris Singer, MAN, RN, CNN December 4, 2008. What’s Going on in Network 11?. Fistula First Lab data collection MRC Recommended Treatment Guidelines Immunization Involuntary discharge. Fistula First. We are Improving!. Almost there… Final State Approaching 50%.

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Network 11 Quality Update

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  1. Network 11 Quality Update Chris Singer, MAN, RN, CNN December 4, 2008

  2. What’s Going on in Network 11? • Fistula First • Lab data collection • MRC Recommended Treatment Guidelines • Immunization • Involuntary discharge

  3. Fistula First

  4. We are Improving!

  5. Almost there…Final State Approaching 50%

  6. We Are Improving!

  7. What Are We Doing to Improve? • Facility goals • Surgeon workshops • Data feedback reports • QI action plans • Patient involvement

  8. We Still Have a Ways to Go… • September 2008 = 49.4% • New Network 11 goal from CMS = 51.3% by 6/30/2009 = 1% per calendar quarter • CMS national goal = 66% by 6/30/2009 • KDOQI Guideline for prevalent AVFs 65%

  9. The Starting PointWhere We Were

  10. The Target Is Moving –Where We Are

  11. Incredible Improvement in 2007

  12. 2008 AVF PrevalenceFacility Goals • Formula used to calculate goals (66% [CMS program goal]) – (facility baseline percent [AVF rate in Q4]) x 20% • Project Design • Baseline: December 2007 • Goal to be achieved by December 2008 data • Progress reports sent out quarterly • Action plans requested after 6 months

  13. Over Three-Fourths (88.8%) of Facilities on Target to Meet Goal!

  14. Early Referral ESRD CKD Management

  15. Upper Midwest Coalition Workgroups • CKD Management • Strategy: Educate nephrologists and physician extenders ways to use CKD care to improve likelihood of AVF placement prior to dialysis start. • CKD Early Referral • Strategy: Use of automatic lab eGFR reporting to alert physicians of early CKD identification. • Train primary care physicians to identify CKD and refer to nephrologist earlier. • ESRD • Strategy: State Survey Provider Tool • Develop facility and patient education strategies that will facilitate AVF improvement

  16. Coalition Successes • All labs in 5-state region participated in GFR survey with over 2/3 automatically reporting GFR • CKD WebEx conducted for primary care physicians • Vascular access coordinator questionnaire in all Network 11 facilities—WebEx's now being developed • Patient resistance focus groups conducted—new patient resources coming! • Acute dialysis education questionnaire conducted

  17. Nephrologist Report Card • CMS Form 2728 Patient Data on Vascular Access • Information collected included: • Patient population: catheter as sole access for dialysis start • Pre-dialysis nephrology care • Surgeon referral • Implemented of model algorithm and education • Follow-up data collected

  18. Overall, more than 60% of patients in Network 11 are seen by a nephrologist at least 6 months before starting dialysis

  19. N = 315 N = 1575 N = 247 N = 1346 N = 3639 N = 7122

  20. Lab Data CollectionElab – 4th Quarter 2007(nearly 100% patient sample)

  21. Network 11 and the Lab Data Collection Project • For Q4 2007 all 18 Networks participated in the project • Lab Data Collection project was completely done in house by Network 11 • Network 11 has been awarded a contract from CMS to officially conduct this project for Q4 2008

  22. National Overall Results

  23. Hemodialysis Adequacy

  24. Hemodialysis Adequacy

  25. Anemia Management

  26. Anemia Management

  27. Phosphorus Control

  28. Phosphorus Control

  29. Medical Review Committee Recommended Treatment Guidelines and Review Criteria

  30. 2008 Clinical Indicators with no changes

  31. Changes for 2008

  32. Elab 2007 Review Process

  33. Review ResultsQ4, 2007

  34. Network 11 Involuntary Discharges

  35. Involuntary Discharge

  36. Involuntary Discharge

  37. What’s Coming in 2009 • QI Projects • Fistula First • Catheter Reduction • Anemia Management • Unused AVF • QAPI • CrownWEB

  38. 2008 – 09 Projects: Fistula First Goals • December 2007 Baseline • All facilities with < 65% AVF Used participating • Based on CMS formula for Networks • Re-measurement using December 2008 data

  39. 2008 – 09 Projects: AVF Placed vs. Used • Collaborative project with 10 facilities • Voluntary participation • Baseline data: Fistula First September 2008 • Facility-specific goals to reduce unused AVF • Interventions include education, quality improvement plans, and data feedback • Re-measurement March 2009

  40. 2008 – 09 Projects: Catheter Reduction • Collaborative project with mentor regional chain of 9 mentor facilities and regional chain of 9 intervention facilities • Baseline data: Fistula First September 2008 • Facility-specific goals to reduce catheters > 90 days • Interventions include education, quality improvement plans, and data feedback • Re-measurement March 2009

  41. 2008 – 09 Projects: Anemia Management • Collaborative project with 8 facilities in MI • Baseline data collected September 2008 • Facility-specific goals to reduce Hgb <10 and Hgb>13 (Target range 11 – 12) • Voluntary participation • Interventions include education, quality improvement plans, and data feedback • Re-measurement March 2009

  42. 2008 – 09 Projects: Quality Assessment & Performance Improvement • Collaborative project with 11 facilities • Voluntary participation • Based on CFC 8 components of effective QAPI program • Interventions include education, quality improvement program assessment, and QI program feedback • Baseline QI program assessment October 2008; re-measurement March 2009

  43. CrownWEB • Patient ESRD data • Clinical data • Fistula First

  44. In Conclusion The mission of the Renal Network of the Upper Midwest is to assess and improve the quality of care provided to patients with end stage renal disease.

  45. Questions?csinger@nw11.esrd.net651-644-9877

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