Slide1 l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 56

Clinical Indicator Goals: Are You on Target? PowerPoint PPT Presentation


  • 178 Views
  • Uploaded on
  • Presentation posted in: General

Clinical Indicator Goals: Are You on Target?. Svetlana (Lana) Kacherova, QI Director July 30 & 31, 2008. Health Care Quality Improvement Program (HCQIP). The Center for Medicare & Medicaid Services (CMS) contracts with 18 ESRD Network Organizations throughout the United States

Download Presentation

Clinical Indicator Goals: Are You on Target?

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Slide1 l.jpg

Clinical Indicator Goals: Are You on Target?

Svetlana (Lana) Kacherova, QI Director

July 30 & 31, 2008


Health care quality improvement program hcqip l.jpg

Health Care Quality Improvement Program (HCQIP)

  • The Center for Medicare & Medicaid Services (CMS) contracts with 18 ESRD Network Organizations throughout the United States

  • The ESRD Networks perform oversight activities to assure appropriateness of services and protection for ESRD patients.

  • This approach has been named the ESRD Health Care Quality Improvement Program (HCQIP)


Number of prevalent esrd patients in the us l.jpg

Number of Prevalent ESRD Patients in the US


Esrd network national goals l.jpg

ESRD Network National Goals

  • Improve the quality of health services & quality of life for ESRD beneficiaries

  • Improve data reporting, reliability, & validity between providers, NWs, and CMS

  • Evaluate and resolve patient grievances

  • Support the marketing, deployment, and maintenance of CMS approved software

    CMS, ESRD NW Organization Manual


Esrd network national goals6 l.jpg

ESRD Network National Goals

  • Establish & improve partnerships & cooperate activities with

    • Providers & Owners

    • NWs, Quality Improvement Organizations (QIOs)

    • State Survey Agencies

    • Professional Groups & Patient Organizations

      CMS, ESRD NW Organization Manual


Network 18 mission statement l.jpg

Network 18 Mission Statement

To provide leadership and assistance to renal dialysis and transplant facilities in a manner that supports continuous improvement in patient care, outcomes, safety and satisfaction.


Network 18 definition of quality l.jpg

Network 18 Definition of Quality

“Doing the right thing correctly

the first time.”


Patients in our network 2006 2007 annual report l.jpg

Patients In Our Network(2006/2007 Annual Report)

  • How Many?

    • Incident – 8,428 / 6,819

    • Prevalent – 27,600 / 29,131

    • Deaths – 5,369 / 5,432


Slide10 l.jpg

Network 18 Patient Distribution by Modality


Delivering care to dialysis patients l.jpg

Delivering Care to Dialysis Patients

  • Dialysis Facilities – (n=305)

    • Ownership

      • Large Corporate (LDO) - 157

      • Non-Corporate (Independent) - 148

    • Location

      • Freestanding

      • Hospital


Goals established by the esrd network based on l.jpg

Goals Established by the ESRD Network based on:

  • Past performance

  • CMS thresholds

  • NKF/KDOQI Clinical Practice Guidelines

  • The expectation is that facilities not meeting expected performance standards will develop internal quality monitors to promote continuous improvement


Clinical performance goals l.jpg

Clinical Performance Goals

  • Provides measurement tool to assess facility patient care processes and outcomes, and identify opportunities for improvement.

  • The Network goal is to combine efforts with renal facilities to improve performance in the delivery of quality patient care


Esrd clinical performance measures cpm project l.jpg

ESRD Clinical Performance Measures (CPM) Project:

  • National effort led by CMS and 18 ESRD Networks that started in 1994

  • Random sample of patients that are representative of each Network

  • For HD patients – (October-December 2006)

  • For PD patients – (October 2006- March 2007)


Five major domains of care l.jpg

Five Major Domains of Care:

  • Adequacy of Dialysis

  • Anemia Management

  • Nutritional Status

  • Bone and Mineral Metabolism

  • Vascular Access


Adequacy of dialysis l.jpg

Adequacy of Dialysis

  • Numerous outcome studies have demonstrated a correlation between the delivered dose of hemodialysis and patient mortality and morbidity

  • Pre and post-dialysis blood urea nitrogen (BUN) levels were drawn and reported to calculate URR results

  • Kt/V was calculated using the pre- and post BUN, post dialysis weight, and time on dialysis


Adequacy of dialysis adult hd pts urr l.jpg

Adequacy of Dialysis: adult HD pts (URR)

The Network’s goal is to achieve 88% of patients with a URR ≥ 65%


Adequacy of dialysis adult hd pts kt v l.jpg

Adequacy of Dialysis Adult HD pts (Kt/V)

The Network’s goal is to have 88% of patients with a Kt/V ≥ 1.2.


2007 annual report opportunities to improve adequacy l.jpg

2007 Annual Report: Opportunities to Improve Adequacy

  • 10% of patients did not have a mean Kt/V > 1.2 during the three-month study period


2007 cpm results u s adult pd patients adequacy of dialysis l.jpg

2007 CPM results U.S. Adult PD patients: Adequacy of Dialysis


2007 cpm results pediatric hd patients adequacy l.jpg

2007 CPM Results Pediatric HD Patients: Adequacy

Opportunities to improve Clearance:

10% of patients did not have a mean sp Kt/V > 1.2 during the three-month study period


2007 cpm results pediatric pd patients clearance l.jpg

2007 CPM Results Pediatric PD Patients: Clearance

Opportunities to improve Clearance:

13% of patients did not have a mean weekly Kt/V > 1.8 during the six-month study period


Network 18 adequacy trends hd pd patients ldc 2007 l.jpg

Network 18 Adequacy Trends (HD & PD Patients) – LDC 2007


Dialysis session time nw 18 l.jpg

Dialysis Session Time: NW 18


Anemia management adult hd pts hgb l.jpg

Anemia Management Adult HD pts (Hgb)

The Network’s goal is to maintain 85% of patients with Hgb > 11.0


2007 cpm results u s adult pd patients anemia management l.jpg

2007 CPM results U.S. Adult PD patients: Anemia Management


2007 annual report opportunities to improve anemia management l.jpg

2007 Annual Report: Opportunities to Improve Anemia Management

  • 16% of patients did not have a mean HGB > 11.0 (g/dl) during the three-month study period

  • 21% of patients did not have a mean TSAT > 20% and 5% of patients did not have a mean Serum Ferritin > 100 ng/ml


2007 cpm results pediatric hd patients anemia management l.jpg

2007 CPM Results Pediatric HD Patients: Anemia Management

Opportunities to improve Anemia:

31% of patients did not have a mean Hgb > 11.0 g/dl during the three-month study period


2007 cpm results pediatric pd patients anemia management l.jpg

2007 CPM Results Pediatric PD Patients: Anemia Management

Opportunities to improve Anemia:

29% of patients did not have a mean Hgb > 11.0 g/dl during the six-month study period


Network 18 anemia management trends hd pd patients ldc 2007 l.jpg

Network 18 Anemia Management Trends (HD & PD Patients) – LDC 2007


Iron studies l.jpg

Iron Studies


Nutritional status adult hd patients l.jpg

Nutritional Status Adult HD patients

The Network’s Goal for dialysis units is to maintain 84% of patients with

a mean serum albumin ≥ 3.5/3.2 gm/dL (BCG/BCP).


2007 annual report opportunities to improve serum albumin l.jpg

2007 Annual Report: Opportunities to Improve Serum Albumin

  • 66% of patients did not have a mean serum albumin > 4.0/3.7 g/dl (BCG/BCP) during the three-month study period

  • 19% of patients did not have a mean serum albumin > 3.5/3.2 g/dl (BCG/BCP) during the three-month study period


2007 cpm results u s adult pd patients serum albumin l.jpg

2007 CPM results U.S. Adult PD patients: Serum Albumin

Opportunities to improve Serum Albumin:

81% of patients did not have a mean Serum Albumin > 4.0/3.7 g/dl (BCG/BCP) during the three-month study period

37% of pts did not have a mean Serum Albumin > 3.5/3.2 g/dl (BCG/BCP) during the three-month study period


2007 cpm results pediatric hd patients serum albumin l.jpg

2007 CPM Results Pediatric HD Patients: Serum Albumin

Opportunities to improve Serum Albumin:

51% of patients did not have a mean Serum Albumin > 4.0/3.7 g/dl (BCG/BCP) during the three-month study period

18% of pts did not have a mean Serum Albumin > 3.5/3.2 g/dl (BCG/BCP) during the three-month study period


Network 18 nutrition management trends hd pd patients ldc 2007 l.jpg

Network 18 Nutrition Management Trends (HD & PD Patients) – LDC 2007


Bone and mineral metabolism adult hd pts l.jpg

Bone and Mineral Metabolism: Adult HD pts)


2007 cpm results u s adult pd patients bone and mineral metabolism l.jpg

2007 CPM results U.S. Adult PD patients: Bone and Mineral Metabolism


Network 18 calcium management trends hd pd patients ldc 2007 l.jpg

Network 18 Calcium Management Trends (HD & PD Patients) – LDC 2007


Network 18 phosphorus management trends hd pd patients ldc 2007 l.jpg

Network 18 Phosphorus Management Trends (HD & PD Patients) – LDC 2007


2007 cpm results vascular access l.jpg

2007 CPM Results: Vascular Access


2007 annual report opportunities to improve vascular access l.jpg

2007 Annual Report: Opportunities to Improve Vascular Access

  • 58% of incident patients and 55% of all patients were not dialyzed with an AVF during their last hemodialysis session Oct-Dec 2006

  • 32% of patients with an AVF or AVG did not have their access routinely monitored for the presence of stenosis during the three month study period


Esrd network 18 vascular access trends 1995 2006 l.jpg

ESRD Network 18 – Vascular Access Trends 1995-2006


What is the most visible qi project in network 18 l.jpg

What is the most visible QI project in Network 18?

  • Fistula First (Fistula First Breakthrough Initiative)


Fistula first goal l.jpg

“Fistula First” GOAL

Goal is to maximize autogenous AVF construction & success rate…..

To achieve in the shorter term (2006) the initial K/DOQI minimum benchmark of AVF use in 40% of prevalent patients….

And in the long-term (2009), a 66% AVF rate in prevalent patients

Additional Goal: Reduce Catheter Use!


Improvement in prevalent avf rates by esrd network l.jpg

Improvement in Prevalent AVF Rates by ESRD Network

FFBI AVF goal 66%


Fistula first goals avf rates l.jpg

Fistula First Goals (AVF Rates)

  • CMS goal – 66% by June 30, 2009

  • Yearly Network 18 goal – 55.1 % by June 30, 2009

  • Yearly Network Stretch Goal – 56.0% by June 30, 2009

  • May 2008 AVF rates: NW 18 – 53.0%

    US – 49.7%


Tools best practices fistula first change concepts l.jpg

Routine CQI Review of vascular access

Timely referral to nephrologist

Early referral to surgeon for “AVF Only”

Surgeon Selection

Full range of appropriate surgical approaches

Secondary AVFs in AFG patients

AVF evaluation/placement in catheter pts

Cannulation training

Monitoring and maintenance

Continuing Education

Outcomes feedback

Tools & Best Practices:Fistula First Change Concepts


New conditions for coverage qapi quality assessment and performance improvement l.jpg

New Conditions for Coverage: QAPI (Quality Assessment and Performance Improvement)

  • Condition Level

  • Interdisciplinary Team

  • Process continuous and on-going

  • Outcome focused: use community accepted standards and targets

  • Include patient satisfaction, infection control, medical injuries and medication errors

  • Plan/Do/Check/Act: Close the loop!


Pdca style l.jpg

PDCA Style

ACT

PLAN

CHECK

DO


Qapi program requirements l.jpg

QAPI Program requirements

  • Action-oriented

  • Data-driven

  • Under the direction of Medical Director

  • Requires RN and interdisciplinary team participation

  • Quality Improvement Committee


Slide53 l.jpg

Quality Improvement Activities

with Providers

  • CMS-approved QIPs (Fistula First)

  • Clinical Performance Measures Project (CPM)

  • Annual Lab Data Collection Project

  • Network-Specific Projects

  • Facility Specific QI Projects

  • Technical Assistance

  • Internal QI Program


Slide54 l.jpg

CMS-Approved QIPs

  • Anemia Management

  • Hepatitis B Vaccination

  • AV Fistula Placement

  • Hemodialysis Adequacy

  • Stenosis Monitoring (100%)

  • Fistula First


Slide56 l.jpg

Svetlana (Lana) Kacherova

Quality Improvement Director

[email protected]

6255 Sunset Boulevard • Suite 2211 • Los Angeles • CA • 90028

(323) 962-2020 • (323) 962-2891/Fax • www.esrdnetwork18.org


  • Login