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Patient Centered Care and the Triple Aims

Patient Centered Care and the Triple Aims. Beverly Hoek, RN, CNN Quality Improvement Director March 14, 2013.

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Patient Centered Care and the Triple Aims

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  1. Patient Centered Care and the Triple Aims Beverly Hoek, RN, CNN Quality Improvement Director March 14, 2013

  2. 'It was this lack of care and communication which resulted in Rory’s death and what we and our daughter Kathleen will live with every day of our lives. We have been handed a life sentence.' Needless tragedy of boy, 12, who died just three days after doctors missed raging infection from cut to arm he got playing basketball

  3. Quality Insights Renal Network 3 “ The Network” • 18 Networks throughout the US • Each State is assigned to a Network • Contract through CMS • 3 Year Contract • QIRN3 - NJ, Puerto Rico and US Virgin Islands • Began a new contract in January 2013

  4. New Jersey ESRD Population 2002-2011

  5. ESRD Patients by County • Atlantic 463 • Bergen 990 • Burlington 559 • Camden 808 • Cape May 110 • Cumberland 360 • Essex 1704 • Gloucester 317 • Hudson 857 • Hunterdon 48 • Mercer 345 • Middlesex 845 • Monmouth 782 • Morris 434 • Ocean 668 • Passaic 736 • Salem 54 • Somerset 158 • Sussex 67 • Union 791 • Warren 82

  6. New Jersey Dialysis Facilities 1990-2012

  7. US 14%

  8. Federal Regulation § 494.180 • Condition – Governance • Standard Designating a CEO or administrator…who exercises responsibility for the management of the facility and the provision of all dialysis services, including, but not limited to— • Staff appointments • Fiscal operations • The relationship with the ESRD Network

  9. (i) Standard: Relationship with the ESRD Network • The governing body receives and acts upon recommendations of the ESRD Network. The dialysis facility must cooperate with the ESRD Network designated for its geographic area, in fulfilling the terms of the Network’s current statement of work. Each facility must participate in the ESRD network activities and pursue Network goals.

  10. Sanctions • The Network has the authority to recommend to CMS that they (CMS) impose Sanctions • Close the dialysis unit • Reduction in reimbursement • CMS will not pay for any new patients on Medicare

  11. Triple Aims • Better Care for the Individual through Beneficiary and Family Centered Care • Better Health for the ESRD Population • Reduce Costs of ESRD Care by Improving Care

  12. AIM I - Domains • Patient and Family Engagement • Patient Experience of Care • Patient –Appropriate Access to In-Center Dialysis Care • Vascular Access Management • Patient Safety: Healthcare-Acquired Infections (HAIs)

  13. AIM II - Domain • Population Health Innovation Pilot Project • Increase Hepatitis B (HBV), Influenza, and Pneumococcal Vaccination Rates

  14. AIM III- Domain • Support for the ESRD Quality Incentive Program (QIP) and Performance Improvement on QIP Measures • Support for Facility Data Submission to CROWNWeb, NHSN, and other CMS- Designated Data Collection System(s)

  15. AIM I Domain: Patient and Family Engagement Domain: Patient Experience of Care Evaluate and Resolve Grievance Promote use of the ICH CAHPS survey Address issues identified through data analysis • Foster patient and family engagement at the facility level • Involve patient/families in CMS meetings • Convene a Patient Engagement Learning and Action Network (LAN)

  16. AIM I Domain: Patient Appropriate Access to In-Center Dialysis Care Domain: Vascular Access Management Improve AVF rates in prevalent patients Reduce catheter rates in prevalent patients Support vascular access reporting Spread best practices Provide technical support Recommend sanctions • Decrease involuntary discharges and involuntary transfers • Address patients at risk for IVD/IVT and failure to place • Generate monthly access to dialysis care reports

  17. AIM I • Domain: Patient Safety : Healthcare - Acquired Infections (HAIs) • Support NHSN • Establish HAI LAN • Reduce Rates of Dialysis Facility Events

  18. AIM II • Population Health Innovation Pilot Project – Decrease Disparities • Increase Vaccinations • Improve Dialysis Care Coordination and Reduce Hospital Utilization • Improve Transplant Coordination • Promote Home Dialysis • Improve Quality of Life

  19. AIM III Domain: Support Data Submission Domain: Support ESRD QIP Assist Facilities in Understanding and Complying with QIP Processes and Requirements • CROWNWeb, NHSN

  20. AIM I • Foster patient and family engagement at the facility level • Involve patient/families in CMS meetings • Convene a Patient Engagement Learning and Action Network (LAN) • Questionnaire Distributed Today – eventually we will be measuring patient participation • Recruit a few patients willing to attend a meeting with CMS • Recruit patients and develop two campaigns and one QIA

  21. AIM I • Evaluate and Resolve Grievances • Promote use of the ICH CAHPS survey • Address issues identified through data analysis • Everything is now a grievance at the Network level • What are you doing with the aggregate scores? • What are you doing to improve your score each year?

  22. AIM I • Decrease involuntary discharges and involuntary transfers • Address patients at risk for IVD/IVT and failure to place • Generate monthly access to dialysis care reports • Two categories now IVD and IVT • What can we do to identify these patients early on and prevent IVD from the beginning • Report IVD/IVTs to CMS

  23. AIM I • Improve AVF rates in prevalent patients • Reduce catheter rates in prevalent patients • Currently we have no accurate data but we will be targeting the lower performing facilities • Reduce Catheters > 90 days- any facility with >10% may have focused intervention

  24. In June 2012, There Were 2,471 Dialysis Patients in New Jersey WITH A cvc!

  25. AIM I • Support vascular access reporting • Spread best practices • Provide technical support • Recommend sanctions • CROWNWeb • Panel discussions at annual meeting • Go to hospitals with you • Big push by CMS to impose sanctions on recalcitrant facilities

  26. AIM I • Support NHSN • Establish HAI LAN • Reduce Rates of Dialysis Facility Events • NW3 has been working on this for 2 years • HAI LAN established in Puerto Rico in March 2012. • Waiting to hear from CMS what actual indicator will be measured.

  27. USRDS Vascular Access Infection Rates in NJ in 2011Mean 1.72/100 Pt Months

  28. Vascular Access Infection Rates in NJ 2012 NHSN Self Reported Data on all Patients

  29. AIM II Increase Vaccinations • Patient Hepatitis B • Staff Flu • Patient Pneumonia • Working in Puerto Rico where they have the highest mortality rate related to Flu and Pneumonia in the USA.

  30. AIM III • Reduce costs…. • Example: In Puerto Rico in the last 12 months, the BSI was has decreased by 16.4%. • They reduced the use of antibiotics by 20% • Each BSI is estimated to cost about $20,000. So in the 4th quarter 2011 in PR, 35 facilities had 190 BSIs = $3,800,000. In the 4th qtr 2012 the same units saved $623,200

  31. Questions? Quality Insights Renal Network 3 109 South Main Street, Suite 21 Cranbury, NJ 08512 609-490-0310

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