Context: Approximately 1500 Discovery Health patients undergo chronic dialysis at any one time.

1. 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 Staden¹1. Discovery Health 2. Independent nephrology practice 3. University of Cape Town 4.Cape Western Reserve University 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 tables and 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 Figure 1 • 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. Figure 2