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Home QIA Kickoff

Barbara Dommert-Breckler, RN BSN, CNN

Quality Improvement Director for Network 16 and 18

bbreckler@nw16.esrd.net

bbreckler@nw18.esrd.net

Participant Expectations

• Enter your name and facility CCN in the chat function

• Mute your line unless speaking/asking questions

• Be engaged

Capacity

• What is your facility’s capacity to add new patients to your current schedule?

ESRD Growth USRDS 2017

• 703,243 dialysis patients as of Dec 31, 2015

• 124,114 new ESRD cases

• 36% of incident ESRD patients received little or no pre-ESRD nephrology care

Where will we put them?

• Assuming an even distribution of new patients between facilities (big assumption)

• 21 patients added per year

Where will we put them?

• Network 18 had 9,480 new ESRD patients in 2015

• With 378 dialysis facilities, 25 new patients a year

• Network 16 had 3,500 new ESRD patients in 2015

• With 207 dialysis facilities 17, new patients a year

QIA 3: Promote Appropriate Home Dialysis

• National goal: by 2023 increase the percentage

of ESRD patients dialyzing at home to 16%

from the 2016 national average of 12%

• Include at least 30% of dialysis facilities within Network service area

• Demonstrate a 10 percentage point increase in rate of patients that start home dialysis training by July 31

How do we get there?

• Patient education

• Staff education

• Say “yes”

• National ESRD NCC Home LAN

Patient Education

• Do you educate patients on different dialysis modalities?

• How?

Patient Education

• All patients receive modality education at the start of in-center dialysis and annually, yet our ICH CAHPS results show that for many years the response to “In the past 12 months, has your kidney doctor or dialysis staff talked to you about peritoneal dialysis?” question has been scored negatively by almost 41% of the responding patients.

Patient Education

• “My Choice” home dialysis video (coming soon)

• Requirement starting in February:

– Show to incident patients between day 31 and 60 of first date of dialysis

– Use this year for annual modality training for all prevalent patients

Patient Education

• Teachable Moments

• Peer to Peer

Staff Education

• By January 31 submit a in-center staff education plan

– Taught by Home nurses or Nephrologist

– Learning sessions with topic and time

– Re-enforcement learning sessions

Staff and Patient Education

• Common Myth and Fact Sheets

• Use these to answer questions

• Leave with patients after modality education

Find Ways to Say “Yes”

• This will be a future webinar

• Assume everyone can be a home modality patient

National ESRD Home LAN

• Required that all project facilities attend and participate on the national LAN

– Learning and Action Network

• We are waiting for the schedule from CMS

QIA 3: Promote Appropriate Home Dialysis

• EACH project facility must track and report to CMS the number of patients in each of 7 steps each month: 1. Patient interest in home dialysis

2. Educational session to determine the patient’s preference of home modality

3. Patient suitability for home modality determined by a nephrologist with expertise in home dialysis therapy

4. Assessment for appropriate access placement

5. Placement of appropriate access

6. Patient accepted for home modality training

7. Patient begins home modality training

• DVA is in negotiations with NCC to batch this data. Patient level detail needed

Seven Step Tracking

• FKC is going to batch this information to us

• DVA is in negotiations to batch information

• Others- CMS (NCC) will provide a template for the information to be sent to the Network in a standard format

– Can your company compile it for you?

How will the Network track our Progress?

• Patients will need to start home modality training

• Training will need to be documented in CROWNWeb

• Facilities without a home program, we will track your patients in CROWNWeb

Primary Dialysis Setting: Home

• Each Treatment Type has own: – Type of Training; Training Begin Date; Training End Date

Primary Type of Treatment: Hemodialysis

Primary Type of Treatment: CAPD

Primary Type of Treatment: CCPD

Primary Type of Treatment: Other

• Type of Training: Hemodialysis

• Type of Training: CAPD

• Type of Training: CCPD

• Type of Training: Other

Treatment (Modality) Info

• Track all Pt Treatments (Modalities at your facility) in Treatment Summary

• Do not delete/overwrite valid Treatment info

• ADD Treatment each time patient changes their Type of Treatment

• The 1st Treatment (Treatment Start Date) must = Admit Date

Training Info

• Training Begin Date must = Treatment Start Date for that Modality

• Type of Training must = Primary Type of Treatment (CAPD in example)

• Training End Date must be updated when Pt completes Training

Things to Remember

Do not delete/overwrite valid treatment info

ADD Treatment each time Pt changes Treatment Type to preserve history

(Treatment Type = Modality)

The 1st Treatment Start Date must = Admit Date

Training Begin Date must = Treatment Start Date

Training End Date must be updated

Summary

• Staff Education plan Due by Jan 31st

– Include your facility CCN (CMS Certification Number)

• Start using My Choice, Home Dialysis video once it arrives, with patients

• Start using the Myth and Fact Sheets

Attendance

Please enter your name and CCN in the chat to get credit for attendance

Contact Information

Barbara Dommert- Breckler bbreckler@nw16.esrd.net bbreckler@nw18.esrd.net

562-986-8858