1999 Annual Statistical Report
II. NETWORK ACTIVITIES
A. Network Goals and Objectives
The Network organizations are responsible for:
Encouraging, consistent with sound medical practice, the use of those treatment settings most compatible with the successful rehabilitation of the patient and the participation of patients, providers of services, and renal disease facilities in vocational rehabilitation programs.
Developing criteria and standards relating to the quality and appropriateness of patient care by working with patients, facilities, and providers; encouraging participation in vocational rehabilitation programs; and by establishing Network goals with respect to the placement of patients in self-care settings and undergoing or preparing for transplantation.
Evaluating the procedure by which facilities and providers in the Network assess the appropriateness of patients for proposed treatment modalities.
Implementing a procedure for evaluating and resolving patient grievances.
Conducting on-site reviews of facilities and providers as necessary, utilizing standards of care established by the Network organization to assure proper medical care.
Collecting, validating, and analyzing data necessary to prepare reports and to assure the maintenance of the ESRD patient registry.
Collecting, validating, and submitting to the Secretary data for inclusion in the national ESRD medical information system.
Identifying facilities and providers that are not cooperating toward meeting Network goals and assisting such facilities and providers in developing appropriate plans for correction. Reporting to the Secretary facilities and providers that are not providing appropriate medical care.
Submitting an annual report to the Secretary that includes a full statement of Network goals, data on the Network's performance in meeting its goals and encouraging participation in vocational rehabilitation programs.
Identifying those facilities that have consistently failed to cooperate with Network goals and recommendations with respect to the need for additional or alternative services or facilities in the Network in order to meet the Network goals, including self-dialysis training, transplantation, and organ procurement facilities.
The following is a listing of goals for The Renal Network, Inc.:
To assist each ESRD patient to reach maximum capacity in achieving independence in employment through increased use of vocational rehabilitation services.
The Renal Network believes this goal area is best met through development and dissemination of education and information to patients and to renal providers, to encourage them to use the vocational rehabilitation services available through established agencies. Rehabilitation activities included the distribution of a finance resources brochure and also the inclusion of vocational rehabilitation topics in newsletters and PAC workshops. This goal area is detailed in section H. Vocational Rehabilitation.
To increase patient involvement in his/her medical care program and in the decision making operations of the Network.
This goal is continuously maintained through the governing structure of the Network, as defined in the bylaws. Eight patient members serve on the governing and policy-making bodies: four on the Board of Trustees and four on the Medical Review Board. Four Patient Advisory Committees (PAC) and a Patient Leadership Committee (PLC) assess the needs of patients, and develop projects based on these needs. Their activities are detailed in Section B. Patient Interaction in Network Activities. The Network philosophy is to increase each patient's awareness of his or her renal disease and treatment, so he or she will be an informed patient, and able to make the most appropriate treatment choices.
To assure patient access to a high quality care including appropriate treatment settings.
Historically, all Network activities have shared the common goal of promoting high quality care within the member dialysis facilities. At the beginning of 1998, the Board of Trustees officially adopted the following as the core purpose of The Renal Network: The Renal Network facilitates the achievement of optimal wellness for renal disease patients. All activities are evaluated to ensure they are in accordance with the core purpose. Implementation of special studies to make practice recommendations and implementation of HCFA initiatives such as core indicators support the goal of assuring access to high quality care. Specific quality improvement activities are outlined in Section D, 1999 Quality Assurance/Improvement Activities.
To maintain a patient specific medical information system, based upon the 1983 HCFA-adopted minimal common data set that permits continual and consistent assessment of the ESRD population and provides data to support quality improvement activities and the Medical Review Board.
The existence of a patient-specific data system has created baseline data which support quality improvement. Through the system, the statistics contained in this report are made possible. The data is used as supportive material to establish benchmarks and to identify facilities with outcomes showing special cause variation. Data collection has enabled Networks 9/10 to monitor facilities and identify trends which may necessitate intervention. The data system is also instrumental in implementing special studies.
To stress the importance of appropriate referral, the The Renal Network has established the annual goals to monitor the rates of home dialysis and transplantation, to ensure these rates meet or surpass national trends.
The Network annually examines the areas of home therapy and transplantation by reviewing facility specific rates. Facilities within Networks 9/10 are maintaining rates in these areas which currently meet or exceed the national norm. Additionally, the Network examines the availability of home therapy services, and the transplant waiting list statistics to ensure appropriate referrals are possible in these areas. These areas are explained as follows.
1. Self Care.
Network 9 developed and adopted a document entitled "Criteria and Standards to Evaluate the Appropriateness of ESRD Care" during 1989. This document contains goals for Network facilities in various aspects of dialysis treatment. (This document was adopted by ESRD Network 10 when it joined Network 9 on August 1, 1996.)
The introductory philosophy statement of the "Criteria and Standards" establishes Network goals for the treatment modalities of self-care and transplantation (listed above in "Network Goals and Objectives"). The Patient Relations Subcommittee of the MRB monitors the rate of home therapy within the Network using the most current data available. In 1999 the subcommittee examined data from 1998. The 1998 data showed the Network rate of home therapy to be 13%, compared to the national average of 12%. The Subcommittee agreed that this was satisfactory. Overall, the percentage of home therapy achieved the Network goal of ensuring that rates of home dialysis and transplantation meet or surpass national trends.
In an effort related to self care, the Peritoneal Dialysis Quality Improvement Project was maintained to improve care to the patients on this modality
The Network maintained a transplantation rate of approximately 4% in 1998, compared to the national average of 4%. The Board reviewed this data and concluded that in light of the current shortage of available donor kidneys, 4% is an acceptable rate. The Board monitors transplantation data on an ongoing basis and will continue to oversee developments in this area. Overall, the percentage of transplantation achieved the Network goal of ensuring that rates of home dialysis and transplantation meet or surpass national trends.
B. Patient Interaction in Network Activities.
The Renal Network maintains an active relationship with the renal community. Through regular communications with the Health Care Financing Administration and the Forum of ESRD Networks, and other professional organizations, the Network provides information of national interest to the local ESRD community, through various and continuous means of communication. To promote patient input and participation in the Network, the following activities were conducted during 1999.
A Patient /Family Needs and Interest Project was completed and the results were made available to PAC Reps, social workers, the PLC, and other interested persons in the Network. Adequacy of dialysis, nutrition, sleep problems, and travel were topics on which more information was desired.
Postcards were sent to new patients to introduce them to the Network and its resources and new patient packets were sent to those who requested it. In November, a New Patient Newsletter that included information about the Network, its grievance procedures, patient rights and responsibilities, as well as patient resources replaced the post card.
Patients participated on Network Committees
New social worker folders were updated to provide a listing of resources and information to share with patients as well as material to encourage patients to become active on the Patient Leadership Committee or the Patient Advisory Committee.
Throughout the year, information about the PAC, PLC, and Patient-to-Patient Program and patient resources were sent to patients and staff who expressed an interest in becoming involved with any of the programs.
C. Cooperative Network and ESRD Medicare Survey and Certification Activities.
During 1999, the Network maintained ongoing cooperative relationships with a wide variety of organizations within the renal and Medicare communities.
The Network maintains and ongoing relationship with Health Care Excel, the organization which administers the peer review organizations (PRO) for both Kentucky and Ohio. The Network is represented on cooperative committees organized by Health Care Excel. The Network met with representatives of KeyPro, the new contractor for the peer review organization for the State of Ohio. Cooperative opportunities were discussed during this meeting.
The Network is represented on the Medicare Partners, a group of organizations with the common goal of assisting Medicare beneficiaries within the states of Indiana and Kentucky.
The Network acts as a resource to the departments of health in the Illinois, Indiana, Kentucky, and Ohio. Interactions between the Network and the state health agencies are ongoing. The Network continuously acts as an expert adviser for the technical aspects of dialysis, and provides Network developed resources when requested.
The Network also provides resources and contacts with other dialysis agencies, such as the American Association for Medical Instrumentation, the National Kidney Foundation and its affiliates, the United States Renal Data Service, and the United Network for Organ Sharing. The relationship between state health agencies and Networks 9/10 continues to develop in a collaborative manner.
The Network participated in the HCFA/Medicare Flu campaign for 1999, distributing information on flu shots to dialysis patients and dialysis facilities and printing information in the patient newsletter, Renal Outreach. Postings were also added to the Network web site. Additionally, information on the hepatitis B vaccine was distributed to all dialysis facilities.
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