Dialysis Facility Compare (DFC) Website Evaluation

1. Dialysis Facility Compare (DFC) Website Evaluation ESRD Stakeholders Meeting March 25, 2004 Michael Trisolini, PhD, MBA RTI International

2. Presentation outline 1. Project Overview 2. Website Presentation & Navigation 3. Facility Characterisics 4. Quality Measures 5. Dialysis and Kidney Disease Information & Links 6. Next Steps

3. 1. Project overview

4. Personnel CMS Project Officer Eileen Zerhusen, RN, BSN DFC Evaluation Project Staff RTI Michael Trisolini, PhD, MBA Amy Roussel, PhD Shelly Harris, MPH Karen Bandel, MPH Philip Salib, BA MEI Dorian Schatell, MS Kristi Klicko, BS

5. Project timetable Sept. 2002 – Nov. 2002 - Planning, recruiting participants Dec. 2002 – June 2003 - Qualitative data collection with 6 types of respondents July 2003 – Oct. 2003 - Reports and recommendations, begin mock-ups of revised DFC Nov. 2003 – Nov. 2004 - Develop and test mock-ups of revised DFC, develop new content

6. General objectives • Gain feedback on current DFC content and features from patients, family members, and professionals • Investigate current patterns of DFC use • Study information needs of potential DFC users • Identify ways to improve the DFC

7. Qualitative data collection • Focus groups • Triads (small focus groups) • In-person interviews • Telephone interviews

8. Locations for data collection • Site visits (about 1 week each) • Washington, DC • Atlanta • Chicago • Phoenix • Telephone interviews

9. Respondent types Number • Dialysis patients & family members 98 • Dialysis professionals & technicians 98 • Pre-ESRD (CKD) patients & family members 42 • Pre-ESRD professionals 8 • Senior staff of dialysis chains, MCOs & DMOs 18 • Senior staff of national renal organizations 6

10. Dialysis patients & family Number • Hemodialysis patients 63 • Peritoneal dialysis patients 12 • Family Members 23 ---- TOTAL 98

11. Dialysis professionals & techs Number • Nephrologists 9 • Nurses 22 • Social workers 29 • Dietitians 25 • Technicians 9 • Renal administrators 4 ---- TOTAL 98

12. General findings - 1 • Few respondents currently using the DFC • HD & pre-ESRD patients pleased to have access to the data on DFC, saw it as relevant, but wanted more data and more user-friendliness • Dialysis family members & PD patients less satisfied • All respondents had many ideas for improvements to DFC

13. General findings - 2 • Dialysis patients perceived to have less choice among facilites when starting, but more later • Variation by site • Pre-ESRD patients & family have many learning needs • Pre-ESRD educational programs are in early stages of development

14. General findings - 3 • Internet access less of a problem than expected • Public reporting of quality data perceived by professionals to have value for quality improvement • MCOs & DMOs saw applications for DFC • CMS perceived as honest broker for dialysis & facility information

15. RTI Recommendations • Based on findings from research • Currently proposals being evaluated by CMS staff • Implementation now under consideration

16. 2. Website presentation & navigation

17. Readability • Aim for 5th grade reading level • Settle for 7th – 9th grade reading level • Provide button to increase font size

18. Reduce density of text • Break long text sections into manageable pieces - “chunking” • Short sentences & paragraphs • Bulleted lists • Columns to limit line length to 30-50 characters • Subheadings

19. Example – current DFC • Read This: The information in Dialysis Facility Compare should be looked at carefully. Use it with the other information you gather about dialysis facilities as you decide where to get dialysis. You should visit any facility in which you are interested and talk with the dialysis facility staff. You may also want to contact your doctor, local ESRD Network or State Survey Agency for more information before you choose a dialysis facility. The telephone number for the local ESRD Network and State Survey Agency can be found in the Helpful Contacts section of this website.

20. Revised DFC Mockup

21. Spanish • Create a Spanish language version of DFC • Use model from Nursing Home Compare • “Vea en Espanol” button on each page in English • “View in English” button on each page in Spanish

22. Increase non-text content • Graphics, photographs, diagrams, cartoons • Mapping function with “zoom” (like MapQuest) • Animation • Audio clips, video clips

23. Revised DFC Mockup

24. Concerns with non-text content • Section 508 – accessibility for visually impaired beneficiaries • Load time • Hardware, software requirements

25. Reduce scrolling • Add headings with hyperlinks • Add tabs and sub-tabs for results

26. Revised DFC Mockup

27. Add user-friendly features for those with little web experience • Tabs or hyperlinks for special populations • PD patients • Family members • CKD patients • Pediatric patients and their parents • Clarify context, “why to use DFC”

28. Revised DFC Mockup

29. Facility characteristics table • Enable facility characteristics table to show 4-6 facilities per screen versus 2 • Reduce font size if needed, with option to switch back to larger font and 2 facilities per screen

30. 3. Facility Characteristics

31. Current DFC

32. Participants suggested many new facility characteristics • Patient issues • Staffing issues • Organizational issues • Policy issues

33. PD patients have special information needs • Number of PD staff • Number of PD patients • PD patients per PD nurse • PD training • PD supplies and equipment

34. Pre-ESRD patients and family made fewer suggestions • Don’t know enough to know what they need to know • Very interested in the experience of receiving dialysis care • Patient checklists would be very helpful

35. Add patient checklists • DFC cannot offer everything • Encourage patients to contact dialysis facilities and providers with specific questions • Provide detailed list of potential areas of inquiry

36. Consider facility characteristics from SIMS database • Review available data elements • Add relevant facility characteristics

37. Consider information on state surveys and inspections • Follows Nursing Home Compare (CMS exploring similar approach for DFC) • Most recent Medicare certification (initial certification date already posted on DFC) • Most recent state survey date • Deficiencies cited • Add to checklist

38. Information on amenities • Topics highlighted by respondents: • Support groups • Visitor policy • Accessibility for people with disabilities • Televisions • Data ports • Cleanliness • Add to checklist

39. Information on scheduling • Shift times • Hours and days of operation • Add to checklist

40. Offer more information about modalities • Availability • How many patients are receiving various modalities • Add to checklist

41. Staffing information • Staffing ratios • Certification or training of technicians • Number staff on site • Clinical staff availability • Add to checklist

42. Revised DFC Mockup

43. 3. Quality measures

44. Adequacy & Anemia 3. Quality measures

45. Presentation – very appealing • Colored bar graphs • Comparisons to national & state averages • Multiple facility comparisons

46. Content • Patients & family members liked comparing facilities • Kt/V & hemoglobin preferred by professionals • But URR & hematocrit considered acceptable • Professionals had some casemix concerns • Age of the quality data was not a major concern for patients & family members, but was for professionals

47. Text explanations – problematic • Glossary definitions too complicated, too long • Explanations above the bar graphs better, but not great • Reading level too high • Too much text – patients & family usually skip over it

48. Patient survival 3. Quality measures

49. Patients & family • Statistical language hard to understand – “better than expected” • Explanation above the results table unclear to many • FAQs better • Most prefer bar graphs (adequacy & anemia) to the check marks in the patient survival results table • Most still wanted to see survival data

50. Professionals • Concern that non-facility factors affect survival • Percent elderly & nursing home residents • Percent poor nutrition or non-compliant • Percent comorbidities • Some understood existing casemix adjustments (age, race, gender, diabetes) but many missed it • Also liked FAQs • Suggested text explanations too complex for patients & family