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Context: Approximately 1500 Discovery Health patients undergo chronic dialysis at any one time. PowerPoint Presentation
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The Discovery Health KidneyCare Programme Developing a Measurement and Feedback System for Improvement.

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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

Context:

Approximately 1500 Discovery Health patients undergo chronic dialysis at any one time.

Problem:

  • 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.

Intervention:

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:

  • Mortality
  • 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

Figure 1

  • 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.

Figure 2