presenters: improving incident vascular access … · physician group practice qapi at the end of...
TRANSCRIPT
Presenters:
Raynel Wilson, RN, CNN, CPHQ, QI Director The Renal Network, Inc.
-Tim Pflederer, MD
Chair, Vascular Access Advisory Panel, Medical Review Board The Renal Network, Inc.
Medical Director, Renal Intervention Center
Welcome to our Webinar:
Improving Incident Vascular Access Outcomes Through
Physician Group Practice QAPI
Tuesday, August 9, 2011
1:00 – 2:00 PM EST
House Keeping Notes
All phone lines will be muted through the entire presentation.
“Questions” may be submitted by clicking the Questions Pane, located on your “GoToWebinar Control Panel”.
Questions may also be submitted via email to [email protected]
Click the “+” in the Questions
Pane.
Type your question and click
[Send to All]
If you don’t see a “Questions” pane,
click [View] and then select
“Questions” from the drop down
menu.
1.2 CEUs has been approved through NANT for Nurses and
Technicians
and
1 CME has been approved for Physicians
To receive CEUs Nurses & PCTs must complete the online
evaluation and Post Test
The link to the evaluation was emailed to all registrants
http://www.surveymonkey.com/s/V9RBSJB
To receive CME Physicians must complete an online evaluation
The link to the evaluation was emailed to all registrants
https://www.surveymonkey.com/s/XKRD6WG
No Later than August 23, 2011
For questions regarding the evaluation process or CEUs/CME contact Cindy
Miller at (317)257-8265 or by email [email protected]
Improving Incident Vascular Access Outcomes Through
Physician Group Practice QAPI
At the end of this webinar attendees will:
Understand the importance of early placement of AVF in CKD patients
Understand the current access trends and challenges related to incident patients
Learn how the incident access report (2728 report) can be used to increase avf and decrease catheters.
Learn how quality improvement efforts can be implemented incrementally to effect change in outcomes.
53.4 55.1 55.3 55.7 56.9 57.3 57.7 58.2 58.2 58.5 58.5 58.6 58.8
60.7 61.7 62.1 62.6 65.3
66.9
0
10
20
30
40
50
60
70
80
90
100
6 9 5 8 11 3 13 4 12 7 10 US 14 2 17 18 1 15 16
% P
ati
en
ts
Network
Percent of Patients with AVF by Network May 2011
Prevalent Fistula Rates May 2011
52.5%
62.2%
54.1% 55.1%
58.5%
66.0%
56.4% 58.2% 58.6%
66.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
IN KY OH Net 9 IL/Net 10 DE PA Net 4 US Best Network
IN KY OH Net 9 IL/Net 10 DE PA Net 4
% AVF Used 17.4% 14.3% 22.6% 19.6% 15.8% 37.9% 21.5% 22.7%
% AVF Placed 35.4% 35.2% 39.4% 37.5% 33.0% 51.7% 39.1% 40.1%
% ALL Cath 76.4% 76.9% 69.7% 73.0% 74.9% 48.3% 71.6% 69.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Incident Access May 2011
2728 Physician Attestation
Patients for whom a nephrologist has signed the 2728 form, attesting that,
“I certify, under penalty of perjury, that the information on this form is correct to the best
of my knowledge and belief. Based on diagnostic tests and laboratory findings, I further certify that this patient has reached the stage of renal impairment that appears irreversible and permanent and requires a regular course of dialysis or kidney transplant to maintain life. I understand that this information is intended for use in establishing the patient’s entitlement to Medicare benefits and that any falsification, misrepresentation, or concealment of essential information may subject me to fine, imprisonment, civil penalty, or other civil sanctions under applicable Federal laws.”
RenalCare Associates
Demographics
11 nephrologists, 13 dialysis facilities, 850 patients
Approx. 200 new patients start dialysis per year
Process for new patients
Each nephrologist follows their own CKD patient
One nephrologist assigned to round on a shift of dialysis patients
2728 completed by the receiving “shift” nephrologist or the medical director
Practice goals
Have opportunity to follow patients in CKD
Place avf prior to patients beginning dialysis
Place avf quickly in patients who are seen too late
Develop processes to ensure avf become useable
Increase the number of incident patients who begin dialysis with avf (decrease catheter)
Achieve the CMS access goals for prevalent patients
> 65% avf
< 10% catheter
Quality Improvement Initiative (Began in 2010)
Utilize the Network 2728 report to increase the number of patients who begin dialysis with a functional avf
Decrease incident and prevalent catheters
Focus on patients in CKD
2728 Report
Strengths
Provides incident data not readily available to our practice
Includes benchmarking data
Weaknesses
Reports by physician or dialysis facility
Physician signing 2728 did not provide CKD care
Not all patients in the dialysis facility received CKD care from our group
Gather baseline data (2009)
Identify the data source (2728 report)
Individual MD information not accurate
Requested 2728 Group report
Evaluated baseline data
Percentage of patients seen in CKD
How long patients are followed in CKD
Incident access types
Functional access at start of dialysis
Patients followed by nephrology (2009)
Length of nephrology care (2009)
Initial access type (2009)
First intervention (2010)
Report data every 6 months
Aggregate group practice data
Individual physician reports
Privately since data does not accurately reflect that doctor’s CKD care
CKD access initiative
Pre-dialysis patient education (TOPS)
Early access placement
Patients followed by nephrology (RCA data)
Length of nephrology care (RCA data)
Initial access type (RCA data)
Second intervention (2011)
Change 2728 completion process
Nephrologist providing CKD care completes 2728
Shift nephrologist completes 2728 for patients who did not receive CKD care
Report data every 6 months
Aggregate group practice data
Individual physician reports
Publically now since the data accurately reflects CKD care
2728 completion process
Old way (focused on rapid 2728 completion)
Patient arrives in HDU and staff obtains most recent H&P, med list
Shift nephrologist reviews H&P and completes the 2728 form
New way (focused on accurate and rapid 2728 completion)
Patient arrives in HDU (Day of or prior to arrival)
Staff requests 2728 from designated nephrology office contact
Nephrology office staff member Gathers recent H&P, progress note, med list, answers: On EPO?
Seen dietician? Etc. Obtains nephrologist completion of 2728 Returns completed/signed form to HDU (Within 2 weeks)
Patients who are referred to the unit from a distance (not a part of our practice) must have 2728 completed prior to acceptance to ensure patient is ESRD and not acute renal failure
Patients followed by nephrology (RCA data)
Length of nephrology care (RCA data)
Initial access type (RCA data)
Access type by length of CKD follow-up
Initial access avf by nephrologist
N = 89 (range 3-19)
Next steps
Improve new consult referral process
Quicker consult
More accurate identification of CKD stage
Evaluate reasons for inter-physician variability
Use of educator/NP, frequency of CKD visits, timing of access referral, use of PD/home therapies, etc
Greater use of protocols based on demonstrated best practices
THANK YOU!
Network 4: PA & DE
Suzanne Kirschbaum, RN,
CNN
Director of Quality Improvement
(412) 325-2250
David Moskovitz, RN
Community Outreach/QI Coord.
(412) 325-2250
Networks 9/10: IL, IN, KY & OH
Raynel Wilson, RN, CNN,
CPHQ
Quality Improvement Director
(317) 257-8265
Cindy Miller, RN, CPHQ
Quality Improvement Coordinator
(317) 257-8265
1.2 CEUs has been approved through NANT for Nurses and
Technicians
and
1 CME has been approved for Physicians
To receive CEUs Nurses & PCTs must complete the online
evaluation and Post Test
The link to the evaluation was emailed to all registrants
http://www.surveymonkey.com/s/V9RBSJB
To receive CME Physicians must complete an online evaluation
The link to the evaluation was emailed to all registrants
https://www.surveymonkey.com/s/XKRD6WG
No Later than August 23, 2011
For questions regarding the evaluation process or CEUs/CME contact Cindy
Miller at (317)257-8265 or by email [email protected]