Achieving Improvement in Kidney Care Quality

Achieving Improvement in Kidney Care Quality June 7, 2006 Part 1. Overview of CMS’ Kidney Care Quality and Performance Improvement Effort. Discussion: What do you think, in general, about the vision and goals for Ideal Kidney Care? Part 2. What Are Improvement Opportunities in the Kidney Care Setting? Kidney Care Stages A. Pre-CKD B. CKD 1-3 C. CKD 3-4 D. CKD 4-5 E. CKD 5 F. End-of-Life Aim Statements A. Pre-CKD: Prevent kidney disease through appropriate management of risk factors. B. CKD 1-3: Early diagnosis and management of CKD and appropriate management of risk factors. C. CKD 3-4: Management of CKD, related comorbidities, and risk factors and patient education about CKD and RRT options. Aim Statements (continued) D. CKD 4-5: Management of CKD, related comorbidities, and risk factors and preparation for / transition to RRT. E. CKD 5: Management of ESRD-related comorbidities. F. End-of-Life: Informed patient decision making. Discussion • What do you think about the proposed improvement opportunities? • Are we leaving something out? • What are the priorities? A. Pre-CKD: Opportunities Prevent kidney disease through appropriate management of risk factors A1. Identify patients at risk for CKD A2. Hypertension A3. Diabetes management A4. Obesity management A5. Tobacco cessation B. CKD 1-3: Opportunities Early diagnosis and management of CKD and appropriate management of risk factors B1. PCP adherence to CKD guidelines B2. Neph. adherence to CKD guidelines B3. Early education to patients about CKD and contributing factors B4. Patient self-management C. CKD 3-4: Opportunities Management of CKD, related comorbidities, and risk factors and patient education about CKD and RRT options C1. Management of mineral metabolism C2. Anemia management C3. PCP adherence to CKD guidelines C4. Neph. adherence to CKD guidelines C5. Evaluation for optimal modality of RRT C6. Timely referral to nephrologists C7. Informed decision-making re: RRT C. CKD 3-4: Opportunities Management of CKD, related comorbidities, and risk factors and patient education about CKD and RRT options (continued) C8. Patient self-management C9. Proper medication control and safety C10. Proper immunizations C11. Patient satisfaction C12. Job retention for working-age patients C13. Vocational rehabilitation, active participation D. CKD 4-5: Opportunities Management of CKD, related comorbidities, and risk factors and preparation for / transition to RRT D1. All previous opportunities plus, D2. Proper treatment of comorbid conditions D3. Decrease undiagnosed, untreated and uncontrolled depression D4. Evaluation for an AVF including vessel mapping E. CKD 5: Opportunities Management of ESRD-related comorbidities E1. Increased number of successful transplants E2. Increased use of patient-centered therapies E3. Use of AVF as preferred source of access E4. Reduction in catheter for long-term dialysis E5. Malnutrition E6. Limb/loss E. CKD 5: Opportunities Management of ESRD-related comorbidities (continued) E7. Vaccinations E8. Reducing bloodstream infections E9. Reducing transmission of bloodborne pathogens E10. Reduction in chronic inflammatory states may also reduce CVD and related adverse outcomes E11. Reducing incidence and prevalence of antimicrobial resistant infections E12. Improving laboratory diagnostic capabilities and reporting of culture and sensitivity results E. CKD 5: Opportunities Management of ESRD-related comorbidities (continued) E13. Reducing occurrence of other adverse events E14. Job retention for working-age patients E15. Improve patient centeredness E16. Patient self-care E17. Physical and mental functioning E18. Improve patient safety F. End-of-Life: Opportunities Informed patient decision making F1. Improve end-of-life care Lunch Break Review Priorities Pre-CKD…End-of-Life Priority #1 Stage Pre-CKD CKD 1-2 CKD 3 CKD 4 Priority #1 A1 Priority #2 Priority #2 A3 Priority #3 Priority #3 A2 D1 (35) E17 F3 D4 (31) E1 F2, F5, F7 D7 E3 CKD 5 End-of-Life Part 3. What Activities Need to Occur to Realize the Improvement Opportunities? Insert Bill’s Slides Discussion: Priorities • Are we missing any metrics? • Are there any related measure development activities underway? • What action needs to occur? • Who needs to take the action? – Patient? Practitioner? Provider? • Who can make the action happen and how? – – – – CMS (billing/policy/regulation)? CMS (QI)? Providers? Other Partners? Priority #1: C3 PCP Adherence to CKD Guidelines • Insert Metrics Priority #2: • Insert Metrics Priority #3: • Insert Metrics Priorities by Stage: Pre-CKD Priorities by Stage: CKD 1-3 Priorities by Stage: CKD 3-4 Priorities by Stage: CKD 4-5 Priorities by Stage: CKD 5 Priorities by Stage: EOL