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 tablesand 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

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 Staden¹ 1. Discovery Health 2. Independent nephrology practice 3. University of Cape Town 4.Cape Western Reserve University

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.

Lessons learnt

• This non-punitive programme has promoted collaboration within this environment. • It is important to have both international and local expert mentorship and supervision.

• Data needs to be complete and accurate to ensure that the clinicians find it credible. • Collecting data electronically dramatically improved the quality of data.

• Constant communication with nephrologists and providers of dialysis is necessary. • Progressive improvement of the reports is vital

Figure 1

Figure 2

9.57%11.21%

13.79%

Phase 7 KidneyCare patients in the period 1 June 2012 - 1 March 2013

All Discovery Health chronic dialysis patients not enrolled on the KidneyCare programme

in the period 1 June 2012 - 1 March 2013

All Discovery Health chronic dialysis patients over a 5 year period

Overall Mortality Rate

0%

2%

4%

6%

8%

10%

12%

14%

16%

5% 10%

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Perc

enta

ge o

f pati

ents

Overall avg clinical outcome measure percentage bands

Population distributions of average scores

Phase 7

Phase 8

Shift in distribution