In October 2017 ESRD Networks received a new statement of work (SOW) from the Centers for Medicare & Medicaid Services (CMS). This document outlines the quality improvement activities (QIAs) that each Network is required to implement within its service area during 2018. This new SOW includes many changes to the requirements of the previous SOW. While the number of QIAs reduced from eight to four, the scope of the QIAs expanded significantly:
The number of facilities required to participate in QIAs has increased; this increase, in turn, significantly expands the number of patients that will benefit from the quality improvement activities being conducted. Any facility that is working with the Network on a QIA will be required to participate in national Learning & Action Network (LAN) webinars, hosted by the ESRD National Coordinating Council (NCC) on behalf of CMS (See article in this issue, “Facility Involvement in Learning & Action Networks: A 2018 CMS Requirement”). The QIAs are patient centered, and each participating facility is encouraged to have patients work hand-in-hand with management and the facility’s QAPI teams to ensure the success of the QIA’s goals. A brief description of each QIA, its scope, and the CMS goals follow.
Reduce Rates of Bloodstream Infections (BSI)
Fifty percent of the Network’s facilities, those with the lowest semi-annual pooled mean rates of BSI, will participate in the BSI QIA. Staff at these facilities will receive education and training on implementation of the CDC Core interventions and will be invited to the NCC LAN BSI events. Those facilities selected for participation in this QIA will be subdivided into three intervention cohorts, each of which will have different focused goals, activities, and measures of success. Network staff will work with each of these cohorts on specific quality improvement measures to achieve the goals of the QIA.
The graphic to the right identifies the three cohorts and the following lists the goal for each cohort:
- Each facility in the BSI cohort will work to reduce its semi-annual pooled mean rate of BSI by 20%.
- Facilities in the Long-term Catheter (LTC) cohort will work to reduce the LTC count by two percentage points.
- Facilities in the Health Information Exchange (HIE) cohort will work to participate in an HIE or in some other evidence-based effective information transfer system.
Improve Transplant Coordination
This year Network staff will work with 30% of the facilities in our service area to increase, by 10 percentage points over baseline, the number of eligible patients on the transplant waitlist. Network staff will work with transplant centers and in-center facilities to meet this goal. Network staff will work with facilities to monitor patient progress using the Seven Steps to Waitlist Process outlined in the table to the right.
Promote Appropriate Home Dialysis
The Network staff will work with 30% of the facilities in its service area to increase the number of patients trained in a home modality. The goal is to increase the initiation of home training by 10 percentage points over baseline. In collaboration with physicians and in-center staff, Network staff will work to create a culture of “home first.” Network staff will work with facilities to monitor patient progress toward the goal of initiating home training using the Seven Steps to Home Modality Training as outlined in the table to the right.
Population Health Focused Pilot QIA (PHFPQ): Vocational Rehabilitation
For the PHFP QIA, the Network will focus on supporting ESRD patients in attaining gainful employment through vocational rehabilitation. Working with 10% of the dialysis facilities in its service area, the Network will seek to increase referrals to approved vocational rehabilitation programs by 5%, with the ultimate goal of increasing in enrollment in vocational rehabilitation services by 2% from baseline to re-measure. Additionally, Network staff will identify a disparity within the target facilities and work with the targeted population to decrease the gap in services.
