1999 Annual Statistical Report

3. Networks 9/10 CPM Interventions.

The goals of the CPM interventions are to:

Interventions included facility and physician data collection, feedback reports, and regional education workshops. The focus was on DOQI™ guidelines, physician-patient outcome data, and facility plans for improvement. Corporate and practice feedback reports were distributed. Feedback reports were specifically targeted to physicians, medical directors, administrators and nurse managers. Multi-color reports displayed data in tables, charts and health service area maps.

Table D.17. Network 9/10 CPM Feedback Reports to Physicians and Dialysis Programs distributed in 1999 by State and Network 9/10 for each collection cycle.

Review Cycle:

# Physicians

# Facilities

HD 4Q98

542

334

HD April 1999

524

338

HD July 1999

510

341

PD N98-A99

424

176

Physician Activity Sheet Survey (March 1999)

A check box format postcard survey was developed to elicit feedback from physicians regarding the Physician Activity Sheet format, use, appropriateness, and improvements. The survey was distributed to 534 physicians in March 1999; the response rate was 19%.

Results-Current Format:

Results-Format Improvements:

Results-Report Uses:

Results-Assess Overall

In 1999, the Electronic Patient Tracking Program was changed to a Windows –based program, VisionPlus . In VisionPlus , CPM reports were added to provide data reports corresponding to DOQI™ guidelines and CPM target levels. Facilities using the VisionPlus software can generate reports for specific time periods and specific patient demographics.

PD data collections increased from three, two-month collection cycles to three, four-month collection cycles. The four-month cycles are consistent with DOQI measurements of adequacy.

The following describes the current level and the percent change from the 4Q98 to the 4Q99 of HD Networks 9/10 patients meeting the recommended DOQI™ Guidelines for care:

change

The following describes the current level and the percent change from N98-A99 to S-D99 of PD Networks 9/10 patients meeting the recommended DOQI™ Guidelines for care:

change

In 1999, the MRB reviewed the plan that identified 102 HD programs with patient outcomes that were statistically lower at 95% confidence than the Network 9 & 10 rate for URR 65% and Kt/V Daugirdis II 1.2 and/ or HCT 31 vol%. These programs were provided educational opportunities to assist them in improving patient outcomes. Of the total of 102 facilities, 93 (91%) had improved from the baseline.

2000 Interventions. Interventions will continue to include facility, physician, and corporate data collection, feedback reports, and regional education workshops. The focus will be on DOQI™ guidelines, physician-patient, corporate-facility - patient outcome data, and facility plans for improvement. Workshops within corporate structures will be conducted as necessary and/or by request.

Facilities will be targeted for specific interventions based on facility outcomes.

4. HCFA National CPM Project.

All 18 Networks participated in this national quality improvement initiative. Random samples of HD and PD patients were drawn. The HD sample had sufficient size to be representative of each Network. The PD sample size was used for national rates only. Table D.17. shows the comparison of Network 9 and Network 10 rankings for clinical outcomes to the other 16 Networks in the nation for three years.

Table D.18. shows the Network 9 and Network 10 random samples for the HCFA National CPM Project. HD facility survey forms were collected from a national random sample, 16 from Network 9 and 7 from Network 10. The facility survey collected information on facility policies and procedures concerning post BUN sampling and dialyzer total cell volume measurement. Data validation of the national sample was conducted on 5% of the random sample. Networks 9/10 staff abstracted patient charts for this process.

Table D.18. Networks 9 & 10 National Ranking for 4Q96, 4Q97 & 4Q98 Data for Adult ( 18 years) In-center Hemodialysis Patients. Source: 1999 Annual Report, ESRD Core Indicators Project, HCFA, December 1997. 1998, 1999 Annual Report, ESRD Core Indicators Project, HCFA, December 1999.

Clinical

Characteristic

Network 9

4Q96 4Q97 4Q98

Network 10

4Q96 4Q97 4Q98

Percent Patients with Average:

URR 65%

Kt/V 1.2

Albumin 3.5 gm/dl

Hgb 11gm/dL

Hgb 10 gm/dL

HCT 30 vol%

HCT 33 vol%

Ferritin 100 ng/ml

TSAT 20%

% patients receiving EPO with:

HCT value 33-36 vol%

HGB value 11-12 gm/dl

% patients prescribed IV Iron

% patients prescribed EPO Subcutaneous

10

12

14

--

--

8

--

10

14

--

--

4

--

9

7

2

--

--

10

13

13

17

15

6

1

1

8

9

12

10

13

9

7

17

18

8

9

1

1

18

17

17

--

--

17

--

13

6

--

--

13

--

17

17

17

--

--

12

8

15

1

8

13

4

5

17

18

12

16

15

17

16

16

15

16

16

6

6

 

Table D.19. National Clinical Performance Measures Project Network Random Samples,

4Q98 – HD Oct98-Mar99 – PD

Pt. Characteristic

Net 9 HD

# %

Net 10 HD

# %

U.S. HD*

# %

Net 9 PD

# %

Net 10 PD

# %

U.S. PD*

# %

Total

Male

Female

Race

AI/AN

AS/PI

Black

White

Oth/Unk

Age

18 – 44

45 – 64

65+

Primary Diag.

DM

HTN

GN

Other/Unk

494

249

245

4

1

187

290

12

78

165

251

183

123

81

107

100

50

50

1

.2

38

59

2

16

33

51

37

25

16

22

488

236

252

2

6

218

248

2

75

184

229

185

159

61

83

100

48

52

.4

1

45

51

.4

15

38

47

38

33

13

17

8336

4449

3878

169

329

3145

4167

526

1412

3202

3720

3423

2127

1027

1759

100

53

47

2

4

38

50

6

17

38

45

41

26

12

21

125

59

66

1

2

22

100

0

30

62

32

49

27

22

27

100

47

53

1

2

18

8

0

24

50

26

39

22

18

22

71

38

33

0

4

26

39

0

14

34

23

20

22

12

17

100

54

46

0

6

37

55

0

18

48

32

28

31

17

24

1533

760

772

34

56

404

928

111

402

687

444

505

332

299

397

100

50

50

2

4

26

61

7

26

45

29

33

22

20

26

*HCFA 1999 Annual Report, ESRD Core Indicators Project, December 1999.

May not add up to 100% due to rounding


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