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Quality Improvement Overview

A primary goal of the ESRD Networks is to improve the quality of health care services provided to ESRD beneficiaries. Network 8 utilizes various strategies to achieve this goal, such as development and coordination of quality improvement projects, provision of data feedback reports, offer of technical assistance by Network 8 QI staff and Medical Review Board, and provision of educational opportunities and materials.

Areas in need of improvement in Network 8 are identified by:

These areas may be addressed through general measures for all facilities, such as posting educational materials on the website, or by specific Network intervention with targeted facilities, practitioners or regions.

The CMS Conditions for Coverage require each facility to participate in the Network CQI activities, as well as establish their own Quality Assessment and Performance Improvement (QAPI) program to include, as described in the Interpretive Guidance:

Quality of care issues to be addressed by facilities include, but are not limited to, dialysis adequacy, nutritional status, mineral metabolism and renal bone disease, anemia management, vascular access, medical injuries and indentification of medical errors, hemodialysis reuse program (if applicable), patient satisfaction and grievances, and infection control issues.

Additional information and assistance with QAPI activities may be obtained by contacting the QI staff at the Network office.

Current Network 8 Quality Improvement Projects

  1. Fistula First Breakthrough Initiative
  2. Decreasing Central Venous Catheters
  3. Nursing Home Communication Project
  4. Additional quality improvement activities address other Clinical Performance Measures as listed below.

Goals for Clinical Performance Measures/Quality Indicators

Utilizing data collected from facilities, Network 8 profiles facility performance in accordance to the following goals established by CMS and the Network 8 Medical Review Board, for the current Clinical Performance Measures. Facilities will be notified as changes are made to the goals and/or measures.

Measure

*Network 8 Goal

Network Intervention Level

Standardized Mortality Rate (SMR)

≤ 1.0

> 1.0 with significant p-value

Vascular Access:

% of prevalent patients using AVF
% of patients using catheter as only access
% of patient using catheter > 90 days
% of incident (new) patients initiating dialysis with AVF

** ≥ 50%

< 15%

< 10%
≥ 50%

AVF use rate < 40%
Catheter only use ≥ 25%

Anemia Management

% of patients with Hgb < 10.0

 

< 10%

> 15% with Hgb < 10.0

Hemodialysis Adequacy:

% of patients with spKt/V ≥ 1.2

≥ 95%

< 84% (CMS goal) patients with spKt/V ≥ 1.2 or
80% (CMS goal) with URR ≥ 65%

  1. * Network 8 goals are reviewed annually with revisions as indicated by Network-wide facility performance. Revisions of goals are posted to Network 8 website as they occur.
  2. ** 50% of prevalent patients using AVF is the Network 8 short-term goal, which is generally increased each year in effort to meet the CMS "stretch" goal of 66% by June 2009.
  3. Finally, Network goals are consistent with the Measures Assessment Tool (MAT) contained in the Conditions for Coverage, released 10-1008. MAT goals for the above indicators are:
    • SMR -> "1.0 is average; . 1.0 is worse than average; < 1.0 is better than average." Goal is decreased mortality. Facility-specific SMR is contained in the Dialysis Facility Report (DFR). The DFR is mailed to every Network 8 nurse manager, medical director and administrator annually in August.
    • Vascular access
      • "≥ 65% of patients dialyzing via AV fistula, using 2 needles"
      • "< 10% of patients dialyzing via cuffed catheter for more than 90 days"
      • Catheter-only patients are not addressed on the MAT - follow Network goals.
      • Incident patients initiating dialysis with AVF are not addressed on the MAT - follow Network goals.
    • Anemia management -> Surveyors expect " increased % with mean hemoglobin 10-12 g/dL."
      Follow Network goal for % of patients < 10.0.
    • Hemodialysis adequacy -> Surveyors to review "% with spKt/V ≥ 1.2 or URR ≥ 65%. Follow Network goal for specific goal.

Available Resources from Network 8

Click here for a list of available resources from Network 8.