Welcome to the ESRD Network of the South Atlantic Network Council - - PowerPoint PPT Presentation

Dec 5th 1:00-2:00 PM

Welcome to the ESRD Network of the South Atlantic Network Council Meeting We will be starting the webinar momentarily

IPRO ESRD Network of the South Atlantic Network Council Meeting

Dec 5th 2018

Welcome/Opening Remarks

Shannon Wright, Executive Director

Housekeeping Reminders

• This WebEx will be recorded and slides made available on the

Network Website

• All lines have been muted to eliminate background noise
• p. 4

To ask a private question use the Chat section in the bottom right corner of your screen sending to All Panelists To ask a question for the answer to be shared with all Attendees or Privately, use the Q&A section in the bottom right corner of your screen

Meeting Agenda

• Overview of IPRO ESRD Network Program
• Patient Engagement and Patient Experience of Care
• Review of 2019 Quality Improvement Activities

–Intervention Commonalities –Patient Safety – Health Associated Infections –Improve Transplant Coordination –Promote Appropriate Home Dialysis –Supporting Gainful Employment in ESRD Patients

• Information Management
• Emergency Management
• Closing Remarks & Next Steps

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Island Peer Review Organization

• Founded in 1984, IPRO, a national independent, not‐for‐profit
• rganization, holds contracts with federal, state and local government

agencies as well as private‐sector clients nationwide.

• Provides a full spectrum of healthcare assessment and improvement

services that enhance healthcare quality to achieve better patient

• utcomes and foster more efficient use of resources.
• Headquartered in Lake Success, NY and also has offices in Albany, NY,

Hamden, CT, Camp Hill, PA, Morrisville, NC, Princeton, NJ, San Francisco, CA and now, Beachwood, Ohio.

IPRO ESRD Network 2017 Service Areas

(2017 Network Annual Reports)

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IPRO ESRD Program

127,224

ESRD Patients

1,831

Dialysis Facilities

47

Transplant Centers

Network 9

IN, KY, OH

Network 6

GA, NC, SC

Network 1

CT, MA, ME, NH, RI, VT

Patients: 14,669 Facilities: 191 Transplant: 15

Network 2

NY

Patients: 29,851 Facilities: 299 Transplant: 10

Network 9

OH, KT, IN

Patients: 33,556 Facilities: 611 Transplant: 12

Network 6

NC, SC, GA

Patients: 49,148 Facilities: 730 Transplant: 10 NW2 NW1

IPRO ESRD Network 6 Service Area by Facility Ownership (As of October 2018)

8 8 233 Facilities 18,310 Patients 5 Transplant Ctrs 155 Facilities 10,219 Patients 1 Transplant Ctrs 368 Facilities 21,403 Patients 4 Transplant Ctrs

Ownership Patients Facilities FKC 20,966 280 DaVita 16,652 269 DCI 2,375 41 US Renal Care 1,620 32 American Renal Associates 2,230 31 DSI 942 17 Wake Forest 1,716 15 Independents 3,214 71 Veterans 217 6 Totals 49,932 756

ESRD Network Role/Responsibilities

• Improve quality of care for ESRD patients
• Promote patient engagement / patient experience of care
• Support ESRD data systems and data collection, analysis

and monitoring for improvement

• Provide technical assistance to ESRD patients and

providers

• Support emergency preparedness and disaster response

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Facility Participation Agreements

• Confirms your agreement to

participate and cooperate with the goals and activities, including QI projects, as provided in 42 CFR Part 494.180.V772 (i) of CMS regulations.

• May be requested by State

Surveyors during evaluations

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State Percentage Complete Georgia 80.5% North Carolina 88.9% South Carolina 82.8%

Contact Emily Watson ewatson@nw6.esrd.net

Patient Engagement and Patient Experience of Care

Chanell McCain Patient Services Director

Grievance Management and Best Practices

• Development/Enforce Robust Grievance Process
• Foster environment that encourages patients, family members,

caregivers to voice their opinions

• Encourage Positive Resolution focused outcomes
• Establish an Anonymous Grievance Process
• ESRD Network Grievance Poster

–Displayed in every dialysis facility

• Additional Resources

–Dialysis Patient Grievance Toolkit –Dialysis Patient Depression Toolkit

• p. 12

Support for Access to Care Concerns

Reasons for Access to Care Cases:

• At-Risk of Involuntary Discharge
• Immediate Involuntary Discharge
• Involuntary Discharge
• Involuntary Transfer
• Failure to Place
• Loss to Follow Up

Provider Interventions:

• Education on Conditions

for Coverage Guidelines

• IVD Process Guidelines
• Communication Tips
• Patient Care Conference
• Behavioral Contract
• Crisis management
• Mental health resources
• p. 13

Resource topic Needs Identified by Facilities to improve grievance processes

• p. 14

3.60 3.70 3.80 3.90 4.00 4.10 4.20 4.30 4.40 Grievance Management Process Resources to develop or improve your facility grievance process Social Support Resources such as Patient Advocacy Groups and Patient Support Groups Psychosocial Support Resources such as de- escalation and mental health topics Improving Communication Resources for patients and staff Grievance Management Guide for working with the ESRD Network Involuntary Discharge Guide when an involuntary discharge is unavoidable and working with the ESRD Network to prevent involuntary discharges NC SC GA Total

Available Resources

• p. 15
• Involuntary Discharge Resources

–Threats are Not Okay Here Poster –Involuntary Discharge Guide

• Grievance Management Process

Resources

–Dialysis Patient Grievance Toolkit

• Improving Communication

Resources for staff and patients

–Applying Net Forward Energy in Patient Care Webinar –Relationship Centered Communication Webinar

• Psychosocial Support Resources

–Dialysis Patient Depression Toolkit –Depression and Dialysis: Removing the Stigma and Strengthening our Mental Health Webinar –Managing Patients’ Psychological Challenges at Dialysis Webinar

• Social Support Resources

–Patient Peer Mentorship Toolkit

Patient Advisory Committee

• p. 16
• PAC Member

–ESRD Patient or Care Partner interested in learning more about ESRD

• Patient Facility Representative

–Nominated by Facility Social Worker –Participate in Facility QI Activities

• PAC Advisor

–Serve as Patient SME for ESRD Network, NCC, TEPs, and other activities –Support PAC Representatives locally

Improving Quality of Care for ESRD Patients

Alexandra Cruz Loretta Ezell Michelle Lewis

Intervention Commonalities for 2019

• Learning and Action Networks (LANs)
• Focus on Patient and Family Centered Care ‐ Patient Facility Representatives

–Incorporating patients into QAPI / Patient Support groups

• Patient and Professional Training Programs ‐ Patient Health Coach
• Complete NHSN Training and Network Attestation Survey
• Virtual Collaborative Meetings

–Interdisciplinary collaborative approach –Share best practices, Review progress , Provide support

• NCC LAN Calls

–Everyone is invited! –1 staff member mandatory participation –1 CEU provided per call upon registration

• p. 18

Reduce Rates of BSIs and VA LTCs

• p. 19

Purpose:

• Reduce Rates of Blood Stream Infections and Long Term Catheters
• Supporting facility enrollment in NHSN, completion of NHSN annual training

and quarterly data checks

• Assisting dialysis facilities in the implementation of the CDC Core Interventions

Facility Selection Criteria:

• 50% of Facilities in the NW, include facilities with highest BSI rates
• LTC rate >15% from 50% of facilities with the highest BSI rates

Goals:

• BSI – 20% relative reduction from the selected facilities in the cohort
• LTC – 2 percentage points reduction from data available in Oct (July data)
• Assist at least 20% of facilities in the pool of 50% facilities to join a HIE

BSI Reduction - RCA Findings Drive Interventions

• p. 20

Facilities reported lack of patient education

• Facility Educational mailings
• Education Stations

Facilities reported poor patient Hand Hygiene / poor hygiene

• Clean Hands Count for patients and visitors factsheet and brochure
• Patient infection prevention pocket guide
• Making dialysis safer coalition conversation starter

Facilities reported infections were staff related

• Use of CDC Core Interventions

BSI – 20% relative reduction in BSIs

• p. 21

Facility Name State Baseline Rate Improvement SOUTH HENERY DIALYSIS CENTER GA 1.18% 18.65% TUCKER DIALYSIS GA 2.31% 18.24% DENTSVILLE KIDNEY CENTER SC 2.40% 14.03% CAROLINA DIALYSIS PITTSBORO NC 2.21% 12.51% DCI EAST ALBANY GA 0.93% 11.19% SOUTH BRUNSWICK DIALYSIS GA 1.13% 10.18%

CDC Core Intervention Use

• p. 22

2019 Interventions to Reduce BSIs

Knowledge and Practice Assessment

• Root Cause Analysis
• Sustainability

Patient Engagement

• Patient Facility Representative
• Lobby Day/ Education Stations
• Patient Checklist Audits
• Patient BSI Reduction Toolkit

Report Card

• Quantitative Data
• Facility Achievement Levels “”Go

for Zero”

Infection Prevention Champion

• Use and Reporting of CDC Audits

Professional BSI Reduction Toolkit

• p. 23

NHSN -National Healthcare Safety Network

• Healthcare –associated infection tracking system
• Dialysis Event Surveillance training is required of all hemodialysis facilities
• Monthly NHSN reporting of data is needed to meet QIP requirements
• Complete NHSN Training and Network Attestation Survey
• p. 24

LTC Reduction - RCA Findings Drive Interventions

• p. 25

Facilities reported lack of patient education

• PSME Webinar for patient engagement

Facilities reported appointment delays

• Vascular access reduction toolkit, Monthly Catheter Tracking

Tool Facilities reported that patients refused a different access type

• ESRD Forum refusal form

Long Term Cather Reduction

• p. 26

Facility Name State Baseline Rate Improvement NORTH CARROLLTON DIALYSIS GA 15.40% 72.14% DIALYSIS CENTER OF MACON, LLC GA 19.20% 69.84% FRENSENIUS MEDICAL CARE LAKE LANIER GA 21.70% 64.51% FMC DIALYSIS SERVICES SOUTH RAMSEY NC 20.30% 53.96% RED SPRINGS DIALYSIS CENTER NC 21.850 52.11% ATHENS RENAL CENTER, LLC GA 15.30% 44.31%

2019 Interventions to Reduce LTCs

Knowledge and Practice Assessment

• Root Cause Analysis
• Sustainability

Report Card

• LTC Reduction Report Card
• Feedback on participation in

interventions

Patient Engagement

• Patient Facility Representative
• Lobby Day/ Education Stations
• Catheter Reduction Toolkit for

Patients

Patient Health Coach

• Catheter Reduction Toolkit for

Professionals

Monthly Catheter Tracking Tools

• Reporting access planning at

QAPI

Webinars

• Regional Best Practice calls
• p. 27

Improve Transplant Coordination

Alexandra Cruz

• p. 29

Increase Rates of Patients on a Transplant Waitlist

Purpose:

• Promote early referral to transplant and Improve referral patterns by

addressing barriers to the steps of waitlist

National Goal:

• By 2023 increase the percentage of ESRD Patients on the transplant waitlist

to 30% from the 2016 national average of 18.5%

Criteria:

• Identify 30% (235) of dialysis facilities to participate (Baseline: 5 year

average trend Oct 2013‐Sept 2018)

Goal:

• 2% point increase in the natural trend of patients placed on the waitlist for

transplant by September 30, 2019

• p. 30

2018 Transplant Rate NW6

This reflects a reduction of ineligible patients for transplant from total census from ~18,000’s to ~9000s

10.0% 20.0% 10.2% 10.1% 10.2% 10.1% 10.1% 10.1% 19.1% 19.9% 19.6% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% Baseline Goal January February March April May June July August September

Facility Name Baseline Waitlist # Sept 2018 Waitlist # Increase waitlist >4 FMC DIALYSIS SERVICES EAST CAROLINA UNIVERSITY 20 31 +11 FREEDOM DIALYSIS CENTER 37 44 +7 TURNER HILL DIALYSIS 9 15 +6 FRESENIUS MEDICAL CARE CHARLOTTE 33 39 +6 Total Renal Care of North Carolina, LLC 15 20 +5 FRESENIUS MEDICAL CARE LAKE LANIER 7 12 +5

6 Steps Leading to Receiving a Transplant

1) Patient interest in transplant, 2) Referral call to transplant center, 3) First visit to transplant center, 4) Transplant center work‐up, 5) Successful transplant candidate, 6) On waiting list or evaluate potential living donor.

• This year eligibility to transplant will not be accounted for, goal has been

adjusted to 2% increase from total patients.

• Patients at the transplant waitlist PRIOR to January 1st, 2018 will not be

accounted for the monthly rate, only NEW patients at the waitlist during Jan‐ Sept 2019 will receive credit.

• p. 31

2019 Intervention Strategies

• p. 32

Knowledge and Practice Assessment

• Root Cause Analysis
• Sustainability

Report Card

• Quantitative Data
• Facility Achievement Levels

Living Donation Education

• Toolkit for patient and donor candidate
• Webinars
• Lobby Education Initiative

Patient Engagement

• Patient Facility Representative

Interdisciplinary Team Approach

• Discipline‐Specific Webinars
• Patient Health Coach

Southeastern Kidney Transplant Coalition

Southeastern Kidney Transplant Coalition

• p. 34

T-Rex – Transplant Referral Exchange

1 2 3 4 5

Ability to select Facility and Transplant Center Key Metric Counts (aggregate view of dialysis centers reports) Expandable section to show charts Multiple views of Reports – By Clinic, By Time (others can be added) Detailed Clinic Report based on main selection criteria (with drill-down to clinic details)

6

Ability to save personal reports, customize, and download

Supporting Gainful Employment in ESRD Patients

Alexandra Cruz

Support Gainful Employment of ESRD Patients

• Purpose:

–Assist ESRD patients with seeking gainful employment and/or returning to work –Collaboration with Employment Network (EN) and/or State Vocational Rehabilitation (VR)

• Criteria:

–10% of dialysis facilities in the Network service area (80 Facilities) –Patients 18‐54

• Measures:

–Baseline: October 2017 – June 2018 / Re‐measure: September 30, 2019

• Goal:

–10% point improvement of patients referred to an EN and/or a VR –5% point improvement of patients utilizing the services of EN and/or a VR –Demonstrate a decrease in the disparity gap

• p. 36

Support for Gainful Employment: Referrals

• p. 37

Facility Name State Baseline Rate Improvement

BMA OF BEATTIES FORD INC NC 5.06% 166.67% FRESENIUS MEDICAL CARE SOUTH COLUMBIA SC 0.00% 150.00% DAVITA JONESBORO DIALYSIS CENTER GA 3.60% 107.69% SOUTHPOINT DIALYSIS NC 3.61% 100.00%

Support for Gainful Employment: Receiving Services

• p. 38

Facility Name State Baseline Rate Improvement

ARBOR PLACE DIALYSIS GA 0.00% 33.33% BUCKHEAD DIALYSIS GA 0.00% 16.67% FRESENIUS MEDICAL CARE SOUTH COLUMBIA SC 9.89% 25.00% BMA OF MARIETTA INC GA 0.00% 14.29%

2019 Intervention Strategies

• p. 39

Knowledge and Practice Assessment

• Root Cause Analysis
• Sustainability

Virtual Collaborative Meetings

• Share best practices
• Work with Vocational Rehab Agencies

and other stakeholders

Patient Engagement

• Patient Facility Representative

Lobby Education Initiative

• Collaboration of facility staff,

patients and VR resource fair

Promote Appropriate Home Dialysis

Michelle Lewis

Increase Rates of Patients Dialyzing at Home

National Goal:

• By 2023, increase the number of ESRD patients dialyzing at home to

16% from the 2016 national average of 12% Purpose:

• To promote referral to home dialysis modalities,
• Identify and mitigate the barriers to timely referral, and
• Determine the steps to improve referral patterns

Criteria:

• Identify 30% of dialysis facilities to participate (235 Facilities)

Network/Facility Goal:

• Demonstrate a 2 percentage point improvement in the natural trend of

patients using a home modality

• p. 41

7 Steps Leading To Home Dialysis Utilization

1) Patient interest in home dialysis (after assisting the patient to determine modality options that fit the patient’s lifestyle), 2) Educational session about home modality, 3) Patient suitability for home modality determined by a nephrologist with expertise in home dialysis therapy, 4) Assessment for appropriate access placement, 5) Placement of appropriate access, 6) Patient accepted for home modality training, 7) Patient begins home modality training.

• p. 43

Increase Home RCA Findings Drive Interventions

Facilities reported Lack of Patient Interest / Fear of Unknown

• Education Stations
• Patient Peer Mentorship

Facilities reported lack of patient education

• Educational Mailing

Facilities reported lack of staff education / No referrals

• Educational Poster
• Baxter Webinar
• Professional Training

Home Dialysis Utilization: 10% increase – OY2

• p. 44

Facility Gains from Baseline: < 30% (7) < 20% (20) < 15% (30)

Facility Name State Baseline Rate Improvement FRESENIUS MEDICAL CARE MIDTOWN SC 7.44% 44.26% DAVITA DIALYSIS OF RUTHERFORD COUNTY INC NC 1.71% 40.68% SNAPFINGER DIALYSS GA 0.44% 39.56% FRESENIUS MEDICAL CARE HONEYCREEK DIALYSIS, LLC GA 2.86% 35.60%

2019 Intervention Strategies

• p. 45

Knowledge and Practice Assessment

• Root Cause Analysis
• Sustainability

Provider Education

• Patient Health Coach
• Webinars
• MATCH‐D – Method to Assess

Treatment Choices for Home Dialysis Calculate by QxMD App Report Card

• Quantitative Data
• Facility Achievement Levels

“Bringing Home the Gold”

Patient Engagement

• Patient Facility Representative
• Lobby Day/ Education Sessions
• My Life, My Dialysis Choice –

Decision Aid (MEI Tool) Kidneys and Me App

Emergency Management

Michelle Lewis

The Network’s Role in an Emergency

• Work with Federal, State and local government agencies as needed to

assist with patient safety and ensure dialysis facilities are prioritized to be open,

• Assist with, track and report patient access to treatment, and
• Report and publish the status of facility operations during emergency

events,

• Be prepared to transition responsibilities to the back‐up Network if

Network operations are impacted.

• p. 47

Emergency Management Cycle

• Mitigation
• Preparedness
• Response
• Recovery
• p. 48

Approach crisis events using the four phases of emergency management:

State DHS/OEM County OEM

ESRD Network

State DOH ESRD Patients Dialysis Facilities

• Establish plans / relationships with local emergency management

services during “Blue Sky” periods

• Maintaining service for as long as possible prior to events that

require evacuation

• Data Management ‐ updated contact, address, emergency contacts

and evacuation plans for tracking patients post event

• Patient Communication

–Understanding impacts of not evacuating

–Clear instructions on where to establish treatment services post event –Knowing the phone number of the person that may call them after the event

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2018: Florence and Michael – Lessons Learned

Critical Asset Survey is a database standardizes important ESRD facility resource information into a single repository available to the Network in the event of an emergency.

• Staff disaster contacts
• Communication methods
• Back Up Water Supply
• Generator capability

Your completion of this survey will provide us with information we need to better serve you during an emergency. Emergency Preparedness for Facilities Critical Asset Survey: https://network6.esrd.ipro.org/home/provider/patient- services/emergency-information/

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Critical Asset Survey

State Percentage Complete Georgia 75% North Carolina 78% South Carolina 70%

Emergency Management – Preparing for 2019

• p. 51

Facility Reporting/Tracking

• Critical Asset Survey

Prepare patients for an Emergency

• Be prepared patient worksheet
• Snowstorm Health: Tips for people on Dialysis

Prepare your facility for an Emergency

• Get to know your local Emergency

Management Coalition

• Participate in coalition meetings
• Contact your coalition during an emergency

to notify them of your status

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Additional Websites and Apps

 To track hurricanes, use the National Hurricane Center website: http://www.nhc.noaa.gov/ NOAA Weather Radar Live App  For hurricane preparedness ‐ Official website of the Department of Homeland Security: https://www.ready.gov/hurricanes  For assistance before, during, and after disasters: https://www.fema.gov/ FEMA App  For information and resources on medical alerts, recalls, and the latest weather emergencies: https://www.kcercoalition.com/  For the latest news, updates and emergency preparedness information, download the following apps for IPhone and Android: Ready Georgia, ReadyNC, SC Emergency Manager Ready Georgia ReadyNC SC Emergency Manager

Information Management

• p. 53

Jaya Bhargava, Operations Manager Ben Williams, Data Analyst Jasmine Taborn, Data Coordinator

CMS CROWNWeb Data Management Guidelines

• Standardized data management processes
• Separated by tasks and tiers
• Three Tasks

–Data Monitoring (Data quality ‐ accuracy, timeliness, etc.) –Data Measuring (Data comparison to a criteria) –Data Managing (Data collection)

• Three Tiers

–Tier 1: Facilities – Enter data directly into CROWNWeb; update facility personnel with changes and, at least, quarterly –Tier 2: Networks – Provide technical data reporting assistance –Tier 3: QualityNet Help Desk – Support CMS data reporting needs; CROWNWeb locked accounts, EQRS Facility Dashboard, changes to submitted forms, patient merge requests, etc.

• p. 54

CROWNWeb Data Quality Goals

• CMS issued CROWNWeb

Data Quality Goals

• Established key indicators

and goals align with Data Management Guidelines

• Used to assess facility

data submission and performance

• p. 55

CROWNWeb Data Reports from Network

• Review reports and submit missing data in CROWNWeb
• All data submissions are time sensitive but highest priority with

immediate action required are for:

–Missing Clinical Data reports ‐ clinical month closes and cannot be changed –Facility Personnel Report – ensures the most current contact information is available for your facility

• Your CROWNWeb Data contacts receive reports in these areas on a

regular basis.

NEVER send PHI or PII via email to the Network

• p. 56

CROWNWeb Facility Personnel

• p. 57
• Monthly your CROWNWeb Data contact receives report
• Review and ensure Facility Personnel in CROWNWeb is complete and

accurate

IPRO ESRD Network Freshdesk Data Support

• p. 58
• Platform for resolving and tracking

requests for data assistance from facilities in our region

• Online Portal and Knowledge Base

for facilities to utilize

–Review articles related to different support topics –Submit a request for data assistance directly from the website –Email the Network directly at a dedicated email address for Freshdesk data support.

NW6Help@iproesrdnetwork.freshdesk.com

Please send emails to: Or visit our website: network6.esrd.ipro.org

Wrap up

Shannon Wright, Executive Director

Facility Responsibilities

• p. 60
• Participate in Network activities

–Quality Improvement Activities –National Learning and Action Network –Patient and Family Engagement by identifying a Patient Facility Representative –Training Opportunities –Keep personnel information updated in CROWNWeb

• Communicate with the ESRD Network

–Respond to inquiries and requests for information –Report impacts to your facility or patients during an emergency –Contact the Network to discuss patient issues in advance of considering a discharge –Share your successes/challenges/barriers

Important Dates to Remember:

• p. 61
• QIA Kick Off Meetings

–HAI – Monday, December 17th 2:00‐3:00 pm –LTC – Tuesday, December 18th 2:00 – 3:00 –Transplant – Thursday, December 20th 10:00‐ 11:00 am –Home Modalities – TBD –Vocational Rehab ‐ TBD

• Network Annual Meeting

Wednesday May 22nd and Thursday May 23rd Embassy Suites Hotel Cary NC

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Questions or Comments?

ESRD Network of the South Atlantic (Network 6) Staff

Shannon Wright Executive Director swright@nw6.esrd.net Emily Watson Administrative Coordinator ewatson@nw6.esrd.net Loretta Ezell Quality Improvement Director wkungu@nw6.esrd.net Michelle Lewis Quality Improvement Data Coordinator mlewis@nw6.esrd.net Alex Cruz Quality Improvement Coordinator acruz@nw6.esrd.net Jaya Bhargava Operations Director jbhargava@nw1.esrd.net Ben Williams Data Analyst bwilliams@nw6.esrd.net Jasmine Taborn Data Coordinator jtaborn@nw6.esrd.net Chanell McCain Patient Services Director cmccain@nw6.esrd.net Open Position Community Outreach Coordinator

Website http://network6.esrd.ipro.org/

Thank You!

IPRO ESRD Network of the South Atlantic 909 Aviation Parkway, Suite 300 Morrisville, NC 27560 http://esrd.ipro.org/

• p. 64