Hypercalcemia Improvement Project: Network Webinar

1. 2016 QIP QIA:hypercalcemiaorientation webinar March 9th, 2016

2. Network staff • Jason Simmington, MHS, QI Specialist* • Kelly Shipley, RHIA, QI Director • Dany Anchia, RN, QI Coordinator • Aparna Biradar, MPH, QI Analyst • Nathan Muzos, BS, IM Director • Glenda Harbert, RN, CNN, CPHQ, Executive Director • Javoszia Sterling, BA, Outreach Coordinator *denotes project lead

3. agenda • Statement of Work (SOW) • Focus Facility Selection • Interventions • Special focus on the root cause analysis • Timeline • Next Steps • Wrap up

4. Statement of work (SOW)

5. Statement Of Work (SOW) “During the base year of the contract the Network shall work on the topic of Hypercalcemia performance. The improvement target for each facility is at least 25% relative improvement from baseline” • Network selects ≥10 facilities that achieve the poorest performance on the QIA-eligible measure • Network shall complete individual facility RCA and planned PDSA cycle, and report on these tasks by the last business day in MARCH • Perform Root Cause Analysis with Each Facility • Plan PDSA Cycle with Each Facility • Support facilities’ implementation of the PDSA plan • Drop and add new facilities

6. Statement of work (SOW) Project Goals: • Overall Goal • 25% relative improvement for each facility from baseline • Facility Goal • PDSA cycle completed by facility (performance on the QIA measure is at or above the target for 3 consecutive months) • Network Goal • Graduate 8 facilities by the end of option year 1

7. Focus facility selection Data Set • CROWNWeb data • Hypercalcemia Rate is defined as the proportion of patient-months with 3-month rolling average of total uncorrected serum calcium value greater than 10.2 • Provided 3 distinct methodologies for focus facility selection • Network 14 preferred the methodology that contained two levels of restriction • Top 15% of providers defined by the worst hypercalcemia rate (based on 12 month lookback period) • Concentration on top 15 providers defined by the largest mean monthly number of eligible patients

8. interventions • Orientation webinar • Root Cause Analysis (RCA) • PDSA planning session with each facility • Rapid Cycle Improvement (RCI) • Sustainability plans for facilities completing the PDSA cycle • Others (depending on RCA)

9. Interventions: focus on rca • Will utilize Survey Monkey (Link) • Root causes: • Receiving Vitamin D analogue • Calcium based binders • High dietary intake of Ca++ • Use of 3.0 calcium bath • Medication adherence • Nutritional Vitamin D supplement • Extreme hypophosphatemia • Adynamic bone disease • Immobilization/fractures • Severe metabolic acidosis • Malignancy (myeloma, solid tumor) • Sarcoidosis/Tuberculosis • Chalk/dirt pica • Other

10. Interventions: focus on RCA • Two additional questions: • Does the patient have a PTH >600? • If yes, is the patient taking a calcimimetic such as sensipar? • One patient per page • Do not use patient identifiers in Survey Monkey • Do not email PHI to the Network • Fax Patient Key to Network

11. Timeline

12. Next steps • Plan the PDSA Cycle • Will have RCAs analyzed by March 21 • Call will be scheduled with your facility prior to March 28 • PDSA cycle begins April 1st • Monthly monitoring • Monthly data via NCC (plan could change) • Currently planning a patient engagement piece to this project • Reassess at 3 months (July) • RCI if numbers worsen • Release from project after submission of sustainability plan

13. questions If you have any questions or concerns throughout this project, please feel free to contact me via phone (469-916-3806) or email (jsimmington@nw14.esrd.net).