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Florida Renal Administration Annual MeetingAn ESRD Network 7 Update
Helen Rose, MSW, LCSWExecutive Director
End Stage Renal Disease (ESRD) Network 7 & 17
July 18, 2019
Objectives
Today we want you to: • Understand what the Network does and how it supports
dialysis and transplant facilities • Learn about the Network's 2019 activities and
opportunities for learning and quality improvement• Obtain information and resources to assist your facility's
quality improvement efforts
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Network Overview
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The HSAG: ESRD Networks
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Network 7 Is Here to Improve Quality of Care and Health OutcomesNetwork 7:• Uses technology to provide outreach and education
• Serves as a partner in quality improvement with patients, practitioners, healthcare providers, other healthcare organizations, and stakeholders
• Achieves and measures changes at the patient level through data collection, analysis, and monitoring for improvement
• Disseminates and spreads best practices
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Network 7 Is Here to Improve Quality of Care and Health Outcomes (cont.) • Provide emergency preparedness education and
support to the ESRD community
• Receive and addresses patient grievances and access to care issues
• Ensure accurate, complete, consistent, and timely data collection and analysis
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Network 7 ESRD Demographics
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2016 2017 2018
Incidence 8,301 8,270 8,731
Prevalence 30,425 31,700 32,320
Home Dialysis 3,781 3,859 4,097
Hemodialysis 667 642 688
Continuous Ambulatory Peritoneal Dialysis (CAPD)
434 407 375
Continuous Cycling Peritoneal Dialysis (CCPD) 2,674 2,807 3,033
Kidney Transplants 1,002 1,058 1,393
Patient Deaths 5,254 5,882 5,747
Vocational Rehabilitation (VR) 25% 25% 27%
Dialysis Facilities (Medicare Certified) 450 460 485
Transplant Centers 9 10 11
Source: CROWNWeb 2744 Data
2018 Annual Report
The Network 7 Annual Report is available on the Network website here:
https://www.hsag.com/en/esrd-networks/esrd-network-7/network-7-annual-reports/
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2019 Network Quality Improvement Activities (QIAs)
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Network QIA Structure
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National Patient Affinity Groups
• Affinity Groups include patient subject matter experts (SMEs) from all 18 Networks
• Patient SMEs chose to participate with one of the following Affinity Groups: – Bloodstream Infection (BSI) – Home Dialysis– Transplant– Improving Emotional Wellbeing
• Networks are mandated to implement patient-level educational resources developed or identified by the National Patient Affinity Groups in QIAs
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National Patient Affinity Group Resources
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Learning and Action Networks (LANs)
• A LAN is an improvement initiative that brings together healthcare professionals, patients, and other stakeholders to achieve rapid, wide-scale improvement– Learn more about LANs here:
https://www.youtube.com/watch?v=zUnEzRijSBk
• The 2019 LANs focus on:– Reducing BSIs– Increasing the number of patients who start home dialysis– Increasing the number of patients on a transplant waitlist– Improving patients’ experience of care– Addressing Population Health topics– Patient and Family Engagement
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LANs (cont.)
• The QIA LANs are hosted by the ESRD National Coordinating Center (NCC)
• Meetings are held every other month • Meeting invitations are sent to facilities from
the Network • Interventions identified in the LANs will be included
in the QIAs and distributed Network-wide • QIA facilities are required to attend their QIA topic
LAN meetings
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Sharing LAN Best Practices
LAN best practices are shared with all Network dialysis facilities via:• Bi-monthly LAN calls
– All facilities receive invitations
• Bi-monthly emails
• The LAN page on the Network website
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QIA Interventions: Facility Level
The Network requires that facilities: • Conduct Root Cause Analysis (RCA)
• Provide staff education
• Report monthly to the Network
• Monitor and discuss progress of Network QIAs in monthly Quality Assessment and Performance Improvement (QAPI) meetings
• Identify facility level interventions that can be shared with other facilities
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QIA Interventions: Patient Level
The Network requires QIA facilities to:• Identify and facilitate appropriate use of Network
Patient Representatives (NPRs)
• Share and encourage use of patient educational videos about:
BSI reduction The advantages of home dialysis Exploring transplant as a modality choice
• Encourage patient-level evaluation of interventions
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BSI Reduction QIA: Status and Best Practices
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Lower rate indicates better
performance
Best practices include: • Use of the CDC audit tools• Engaging patients in QIA activities, including hand hygiene audits
• Establishing a formal process to obtain blood cultures and hospital records Using a health information exchange (HIE) or other effective
Information transfer system
• Sharing audit results and with floor staff
• Providing staff re-education
Engaging Patients as Partners in Infection Prevention
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Engaging Patients as Partners in Infection Prevention (cont.)
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Find the Test Your Hand Hygiene video at: http://fmqaimedia.com/demo/handwashing/
BSI Reduction QIA Resources
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Long-Term Catheter (LTC) Reduction QIA: Status and Best Practices
Number of Facilities
Number of Patients
Baseline (July 2018)
Goal (July 2019)
Current (April 2019)
39 2,353 19.1% 17.1% 16.7%
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Best practices include: • Identification of a Vascular Access Manager
• Tracking and monitoring patient education, appointments, and outcomes closely
• Developing relationships with hospitals and surgeons
• Reviewing efforts in QAPI meetings
• Providing ongoing patient education
Lower rate indicates better
performance
Network LTC 90–120 Days Comparison
23 Source: CROWNWeb, March 2019
Network LTC Performance
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LTC Reduction QIA Resources
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Home Dialysis QIA: Status and Best Practices
Number of Facilities
Number of Patients
Baseline(January 2019)
Goal(September 2019)
Current(June 2018)
125 8,600 0.0% 539 patients = 100% of goal
293 patients = 54.3% of goal
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Best practices include: • Educating patients early/upon admission and ongoing
• Developing relationships with home dialysis programs, nephrologists, and hospitals
• Referring every new patient to a home program for education and suitability determination
• Tracking and monitoring patient education, referral, and transitions closely
• Identifying a staff home champion
Home Dialysis QIA Resources
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How I Took The Road Home Patient Educational Resources are available on the Network website here and include a:• Video
• Flyer
• Poster
Transplant Coordination QIA:Status and Best Practices
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Number of Facilities
Number of Patients
Baseline (January 2019)
Goal (September 2019)
Current (June 2019)
134 11,091 0.0% 404 patients = 100% of goal
240 patients = 59.4% of goal
Best practices include: • Educating patients early/upon admission and ongoing
Addressing misconceptions Using the Network’s Transplant Guide
• Tracking and monitoring patient education, referrals, appointments and waitlist status closely
• Developing communication processes with transplant centers
• Supporting patients through the waitlist process
Transplant QIA Network Performance
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Transplant QIA Resources
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Transplant Guide
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Link to the Network 7 2019/2020 Transplant Referral Guide: https://www.hsag.com/contentassets/b343e75614a24d7ca967de6e6417f43f/nw72019transplantguide508.pdf
Support Gainful Employment of ESRD Patients QIA
Measure Baseline (October 2017 -
July 2018)
Goal (September 2019)
Current(June 2019)
Screened for Interest in Vocational Rehabilitation(VR)
93.2% 100% 98.0%
VR Referral 1.49% 11.49% 52.6%
VR Referred and Receiving Services
.17% 5.17% 3.6%
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Number of Facilities
Number of Patients (Total Eligible June)
45 262
Higher rate indicates better
performance
Support Gainful Employment of ESRD Patients QIA Resources
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QIA Resources: Available on the Network Website
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Patient and Family Engagement (PFE) at the Facility Level
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PFE Activities
Activity Baseline(February) Goal
Mid-Year Measure
(June)
Establish patient councils, patient and family support groups, and/or new patient adjustment groups
5.8% (26/447)
7.8%19.7%
(88/447)
Incorporate patient, family, and caregiver participation into the QAPI Program and governing body of the facility
5.1%(23/447)
6.8%16.3%
(73/447)
Develop policy and procedures related to patient, family, and caregiver participation in the patient’s POC
18.8%(84/447)
25.0%71.8%
(321/447)
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PFE Resources
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PFE Resources (cont.)
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Patient and Family involvement Resources can be found on the Network website here: https://www.hsag.com/en/esrd-networks/esrd-network-7/patient-and-family-engagement-pfe/
The NPR Program:• Was implemented with all
QIAs in 2019
• Is intended to: Help spread educational
information to patients Assist with QIA activities Improve the patient
experience in the facility
NPR Program Background
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• As of July 8, 2019, facilities have recruited and registered 104 NPRs
• All NPRs and facility leads received an email from the Network with a list of activities to consider
NPR Program Basics
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• An NPR is an individual who:– Is on dialysis or who has had a
kidney transplant.– Volunteers at their facility or
a facility in their area.
• Facilities are encouraged to engage NPRs in the QAPI program
• NPR materials are available on the Network 7 website
Potential NPR activities
Consider using NPRs to:
• Provide the patient perspective for QIAs that the
facility is participating in with Network 7
• Pass out Network 7 educational resources or
newsletters to patients
• Participate in the facility’s monthly QAPI meetings
• Act as a greeter for patients that are new to the facility
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Potential NPR Activities (cont.)
• Support patients who are transitioning to home dialysis or are being worked up for transplant
• Help staff members plan and host special events and/or holiday celebrations
• Assist with Lobby Day planning and education
• Develop a bulletin board based on the educational needs of patients in your facility
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Emergency Management
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Emergency Management Expectations of ESRD Facilities
• Notification must be made to the Network if a facility’s operational status changes or patient access to care is compromised ― Notification of the Network can be made by:
▪ Phone: 813.383.1530▪ Email: [email protected]
• Facilities must respond to Network requests for information regarding facility or patient status
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Emergency Management Expectations of ESRD Facilities (cont.)
• Facilities must update CROWNWeb quarterly
• Facilities should follow standard admission practices when receiving requests to treat patients who are displaced or have evacuated from storm areas Requests should be addressed timely Displaced or evacuated patients should be reported to the Network via phone or fax
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Network 7 Staff Directory
Helen Rose, MSW, LCSWExecutive Director
813.865.3321 [email protected]
Donna DeBello, RN Quality Improvement Director
813.865.3363 [email protected]
Beverly Whittet, RN, CDN, CPHQSpecial Projects Director
813.865.3317 [email protected]
Allison Boutwell, MSW, LCSWPatient Services Manager
813.865.3460 [email protected]
Kristine Johnson, RN, BSN, MSNQuality Improvement Manager
813.865.3454 [email protected]
Bonnie Grasso, MSWQuality Improvement Manager
813.865.3415 [email protected]
Robert Peck, RNNephrology Nurse
813.865.3474 [email protected]
LeCrystal Williams, BSData Manager
813.865.3323 [email protected]
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Questions
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Thank you!
HSAG: The Florida ESRD Network (Network 7)
813.383.1530
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This material was prepared by HSAG: ESRD Network 7, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy nor imply endorsement by the U.S. Government. FL-ESRD-7A1024-07172019-01