Welcome to the ESRD Network of the South Atlantic Network Council Meeting We will be starting the webinar momentarily Dec 5 th 1:00-2:00 PM
IPRO ESRD Network of the South Atlantic Network Council Meeting Dec 5 th 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 To ask a private question use To ask a question for the the Chat section in the bottom answer to be shared with all right corner of your screen Attendees or Privately, use the sending to All Panelists Q&A section in the bottom right corner of your screen p. 4
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
Island Peer Review Organization • Founded in 1984, IPRO, a national independent, not ‐ for ‐ profit organization, 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 outcomes 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. 6
IPRO ESRD Network 2017 Service Areas (2017 Network Annual Reports) Network 2 Network 1 NY CT, MA, ME, NH, RI, VT Patients: 29,851 Patients: 14,669 NW1 Facilities: 299 Facilities: 191 Transplant: 10 Transplant: 15 NW2 Network 9 OH, KT, IN IPRO Network 9 Patients: 33,556 ESRD Program Facilities: 611 IN, KY, OH Transplant: 12 127,224 Network 6 ESRD Patients Network 6 GA, NC, SC 1,831 NC, SC, GA Patients: 49,148 Dialysis Facilities Facilities: 730 Transplant: 10 47 Transplant Centers 7
IPRO ESRD Network 6 Service Area by Facility Ownership (As of October 2018) Ownership Patients Facilities FKC 20,966 280 DaVita 16,652 269 233 Facilities 18,310 Patients DCI 2,375 41 5 Transplant Ctrs US Renal Care 1,620 32 155 Facilities 10,219 Patients American Renal 2,230 31 1 Transplant Ctrs Associates 368 Facilities DSI 942 17 21,403 Patients 4 Transplant Ctrs Wake Forest 1,716 15 Independents 3,214 71 Veterans 217 6 Totals 49,932 756 8 8
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 9
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 State Percentage Complete Georgia 80.5% Contact Emily Watson North Carolina 88.9% South Carolina 82.8% ewatson@nw6.esrd.net 10
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: Provider Interventions: • At-Risk of Involuntary Discharge • Education on Conditions for Coverage Guidelines • Immediate Involuntary Discharge • IVD Process Guidelines • Involuntary Discharge • Communication Tips • Involuntary Transfer • Patient Care Conference • Failure to Place • Behavioral Contract • Loss to Follow Up • Crisis management • Mental health resources p. 13
Resource topic Needs Identified by Facilities to improve grievance processes 4.40 4.30 4.20 4.10 4.00 NC 3.90 SC 3.80 GA Total 3.70 3.60 Grievance Social Support Psychosocial Improving Grievance Involuntary Management Resources such as Support Resources Communication Management Guide Discharge Guide Process Resources Patient Advocacy such as de- Resources for for working with the when an involuntary to develop or Groups and Patient escalation and patients and staff ESRD Network discharge is improve your facility Support Groups mental health topics unavoidable and grievance process working with the ESRD Network to prevent involuntary p. 14 discharges
Available Resources • Psychosocial Support Resources • Involuntary Discharge Resources – Dialysis Patient Depression – Threats are Not Okay Here Poster Toolkit – Involuntary Discharge Guide – Depression and Dialysis: • Grievance Management Process Removing the Stigma and Resources Strengthening our Mental Health – Dialysis Patient Grievance Toolkit Webinar • Improving Communication – Managing Patients’ Psychological Resources for staff and patients Challenges at Dialysis Webinar – Applying Net Forward Energy in • Social Support Resources Patient Care Webinar – Patient Peer Mentorship Toolkit – Relationship Centered Communication Webinar p. 15
Patient Advisory Committee • 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 p. 16
Improving Quality of Care for ESRD Patients Michelle Lewis Alexandra Cruz Loretta Ezell
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 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 p. 19
BSI Reduction - RCA Findings Drive Interventions 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 p. 20
BSI – 20% relative reduction in BSIs Facility Name State Baseline Rate Improvement GA 1.18% 18.65% SOUTH HENERY DIALYSIS CENTER GA 2.31% 18.24% TUCKER DIALYSIS SC 2.40% 14.03% DENTSVILLE KIDNEY CENTER NC 2.21% 12.51% CAROLINA DIALYSIS PITTSBORO GA 0.93% 11.19% DCI EAST ALBANY GA 1.13% 10.18% SOUTH BRUNSWICK DIALYSIS p. 21
CDC Core Intervention Use p. 22
2019 Interventions to Reduce BSIs Report Card Knowledge and Practice Assessment • • Root Cause Analysis Quantitative Data • • Facility Achievement Levels “”Go Sustainability for Zero” Patient Engagement Infection Prevention Champion • • Patient Facility Representative Use and Reporting of CDC Audits • Lobby Day/ Education Stations Professional BSI Reduction Toolkit • Patient Checklist Audits • Patient 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
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