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Network of New England An Educational Day

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Mid-Atlantic Renal Coalition (Network 5) Patient ... Term of service is 2 years but can be renewed to a max ... and MRB rotate off at each election cycle. ... – PowerPoint PPT presentation

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Title: Network of New England An Educational Day


1
Network of New England An Educational Day
Time Out For Technicians
  • April 24, 2008

Douglas Shemin, MD Network Chairman
2
(No Transcript)
3
ESRD Network Organization
  • ESRD Medicare Program Public Law 92-603 in 1972.
  • Medicare coverage for ESRD began July 1973.
  • ESRD Network Coordinating Councils (32 areas)
    established in 1978, consolidated to 18 networks
    in 1988.
  • Network Organizations are independent
    contractors. Performance evaluated by CMS
    annually. 2/18 networks now administered by QIOs
  • Contracts renewed every 3 years based on
    performance.
  • Network of New England, Inc. (not-for-profit
    corporation) has held the ESRD Network contract
    for 30 years.
  • New contract effective July 1, 2006 for three
    years.

4
ESRD Network Organization
  • Each network has paid staff, volunteer Board of
    Directors (BOD), volunteer Medical Review Board
    (MRB). The MRB reviews, suggests QI projects,
    reviews grievances and complaints), and patient
    advisory committee.
  • BOD and MRB made up of nephrologists, nurses,
    dieticians, social workers, administrators,
    transplant professionals, patient
    representatives and technicians.
  • Network of New England welcomes interested renal
    professionals to our BOD and MRB.

5
What do the Networks do?
  • Collect data (demographics, comorbidity,
    mortality information) on gt 400,000 patients in gt
    4000 facilities
  • Assess Data Identify QI needs on a local level,
    institute and administer QI projects, offer
    assistance to underperforming facilities
  • Respond to grievances, complaints, concerns by
    patients, families, and facilities.
  • Special projects

6
New England ProviderDistribution
7
Number of ESRD Providers 2001 2006
 
 
ESRD Resources in New England 12/31/2001
 
 
ESRD Resources in New England 12/31/2006
 
 
8
Modality By State 2001 2006
 
 
2001 Dialysis Prevalence by Modality Provider
of Service
 
 
2006 Dialysis Prevalence by Modality Provider
of Service
 
 
9
Dialysis Patient Characteristics in New
England Dialysis Population 12/31/2006

10
From Network 1 Annual Report 2006 in New
England, 27 working age dialysis patients work,
3 go to school
11
Providers with Treatments after 5PM
12
Dialysis Providers by Ownership12/31/2006
13
Goals adjusted by the BOD/MRB 6/07.
Source CMS/CPM 2006/2007 report, which has
2005/2006 data. Serum Albumin is not considered
a CPM. Note Annual random 5 patient
sample
14
4 targets KT/V gt 1.2, Hgb gt 11, AVF, albumin gt
4
  • Rocco, Annals Internal Medicine, 2006
  • 1 year death rate
  • 4/4 targets 7
  • 3/4 targets 14
  • 2/4 targets 21
  • 1/4 targets 25
  • 0/4 targets 29

15
Why Fistula First?
  • Better solute clearance with AV Fistulae
  • Much lower risk of infection Sixfold greater
    rate of bacteremia with catheters (Hosp Inf
    Disease 2003)
  • Lower risk of death with AV Fistulae (from
    CHOICE Study, JASN 2007)47 higher adjusted
    mortality rate in catheter patients compared to
    AVF patients

16
Prevalent Vascular Access Network 1 and
StateJan. 2007 to Jan. 2008
17
Quality Improvement Initiatives
  • Fistula First increase to 66 by 2009
  • Clinical Performance Measures for focused
    intervention
  • Anemia Management
  • Network Special QI Projects
  • Catheter reduction
  • Nutrition management
  • Patient Safety
  • Facility Specific Quality Assessment and
    Performance Improvement Projects
  • Use data profiles to identify providers needing
    assistance
  • Provide QI technical assistance to dialysis
    providers

18
5 Diamond Patient Safety ProgramESRD Network of
New England(Network 1)Mid-Atlantic Renal
Coalition(Network 5)
19
Patient Safety Culture
  • Pervasive Commitment to Patient Safety
  • Open Communication
  • Blame-free Environment
  • Safety Design
  • Employee Physician Involvement Accountability

20
Objectives
  • To promote patient safety values
  • To create an awareness of patient safety issues
  • To help dialysis units learn more about specific
    areas of patient safety
  • To build a patient safety culture in every
    dialysis unit

21
Educational Modules
  • Patient Safety Principles (required)
  • Hand Washing
  • Flu Vaccination
  • Slips, Trips and Falls
  • Medication Reconciliation
  • Emergency Preparedness
  • Sharps Safety
  • Decreasing Patient Provider Conflict
  • Under Development
  • Staff Adherence to Procedures
  • Dialyzer Set-up Errors

22
Modules
  • Each topic is a complete educational module
  • Tools and resources are located on the Network of
    New England website
  • Required and optional activities
  • PowerPoints for staff in-service presentations
  • Posters for display
  • Games and activities to engage patients

23
Recognition
  • All participants completing at least one
    component or more will be recognized
  • 1 4 Diamonds
  • Acknowledged in Network Newsletter
  • Listed on Network Website

24
Recognition - 5 Diamond
  • Acknowledged in Network Newsletter
  • Listed on Website
  • Special recognition at Annual Network Council
    Meeting
  • 2 free passes to Annual Meeting
  • 75.00 gift certificate for entertainment
    material for patients
  • Plaque to display in unit

25
Details
  • Time frame
  • Starts April 2008 in Network 1
  • Launch project at Technician Meeting
  • April 24, 2008
  • Mass Mailing to all Providers Medical Directors
  • Requires registration to do the program and
    submission of documentation when each module is
    completed by dialysis provider

26
Promote
  • Please go back to your facility and encourage
    your management to participate in this
    educational safety effort.

27
ESRD Community Information Clearinghouse/Resour
ce
  • Promote patient, public, and professional
    education
  • Maintain a resource library of educational
    materials
  • Conduct workshops on quality of care concepts
  • Distribute a newsletter to dialysis and
    transplant facilities
  • Maintain Network website, with QI links
  • Establish partnership and collaborative
    activities
  • Major disaster coordination
  • Assist patients, family or providers
  • Provide consultation or investigation

Complaints/Grievances
28
Network Leadership 3 Face to Face Meetings per
Year
  • Board of Directors 25 to max of 40 members.
    Term of service is 2 years but can be renewed to
    a max of 4 years.
  • Medical Review Board 15 to max of 20 members.
    Term of service is 2 years but can be renewed to
    a max of 4 years.
  • Election to be held in November 2007. Terms
    begin January 2008.
  • 1/3 of BOD and MRB rotate off at each election
    cycle.

29
CMS Conditions of Coverage for ESRD Facilities
Final Rule Published 4/15/08
  • Highlights of Provisions in the Final Rule
    Include
  • Updated CDC guidelines for hemodialysis
    facilities
  • Updated AAMI water quality guidelines
  • Defibrillators in every dialysis unit
  • Incorporates sections of the 2000 Life Safety
    Code for fire safety
  • Option for patients to have an advance directive

30
Highlights of Provisions in the Final Rule
Continued
  • Facilities provide written notice 30 days before
    a patient is involuntary discharged
  • Facilities perform clinical assessment within 30
    days, or 13 hemodialysis treatments, of patient
    starting treatment
  • Home dialysis water purity requirements based on
    updated AAMI standards
  • Facility-level quality assurance and performance
    improvement program

31
Highlights of Provisions in the Final Rule
Continued
  • Minimum qualifications and training requirements
    for patient care technicians (PCTs)
  • Responsibility of Medical Director for Quality
    Assessment and Performance Improvement (QAPI) and
    involuntary transfers or discharges
  • Electronic data collection and reporting
  • The CMS link to the final rule
  • www.cms.hhs.gov/CFCsAndCoPs/downloads/ESRDdisplayf
    inalrule.pdf

32
Effective Dates
Governance Electronic Data Submission As of
2/1/2009, every facility must electronically
submit data on all patients, including data on
clinical performance measures, to CMS.
33
Thank you for all the good work you do for your
patients
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