The Discovery Health KidneyCare Programme Developing a Measurement and Feedback System for Improvement
E Gottlich¹˒² , C van Rensburg¹, G Kantor¹˒³˒⁴, Rochelle Bates¹, Susan Smith¹, Jon Crawford¹, Paul Claassen¹, Helene van Staden¹1. Discovery Health 2. Independent nephrology practice 3. University of Cape Town 4.Cape Western Reserve University
Approximately 1500 Discovery Health patients undergo chronic dialysis at any one time.
- Limited data existed to assess the quality of chronic dialysis clinical processes and outcomes of all patients and to compare performance.
- Limited quality measurements were available to enable patients, their doctors and their providers of dialysis services to respond to process and outcome measures in order to guide improvement.
This programme has the following aims:
- Ensure joint participation by the patients, their doctor and the provider of dialysis care in improving quality of care.
- To measure and report on the comprehensive management of the patient in order to guide all parties to institute improvement of care programmes.
- To provide educational material to patients via a booklet and a daily SMS health message.
- To improve the quality of life for Discovery Health patients on chronic dialysis.
Outcome measures were obtained from Discovery Health data tables
and process measures from the dialysis units:
Outcome measures included:
- Hospital admission data.
Dialysis process measures included:
- Related laboratory results
- Venous access
- Transplant list registration
- Frequency and mode of dialysis.
Poorly compliant patients were identified via:
- Less than 3 x week haemodialysis for those patients with no renal reserve
- Medication compliance
- Effects of changes:
- Patients, doctors and the providers of dialysis services now get comprehensive data reports on Discovery Health patients.
- The report to the doctors and providers of care reflect aggregated patient data for that provider and compares those patients’ results to national averages.
- The comprehensive patient report and related educational material provided by Discovery Health promotes better engagement by the patient and understanding of their condition.
- Providers have become more diligent in ensuring required pathology testing is performed.
- During the last 5 years mortality rate has decreased and is lower for patients on the programme in phase 7 compared to those who had declined consent for enrolment. (Figure 1)
- From phase 7 (2012) to phase 8 (2013) the average overall dialysis process measure score showed a 5% improvement across the population. (Figure 2)
- The environment is motivated to improve quality of care.