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  1. 1. OUTCOMES 2008 DIVISION OF MEDICINE Department of Nephrology
  2. 2. About Cleveland Clinic Florida Cleveland Clinic Florida’s medical staff are dedicated physicians who have joined the clinic as salaried doctors to practice a different kind of medicine: Where commitment to patients, providing expert innovative care, and involvement in medical education are the goals. We work as a team, access the same electronic medical records, and cooperate to give our patients the best care. Providing excellent care to our patients is why we are here.
  3. 3. 2008 Department of Nephrology TABLE OF CONTENTS: Staff 2 Chair’s Letter 4 Department Overview and 5 Services Offered Innovation 8 Staff Mauro Braun, M.D. Beth Leventhal Fromkin, M.D. Rute Paixao, M.D. Dianne Sandy, M.D
  4. 4. 2008 Chair’s Letter The Department of Nephrology and Hypertension is committed to the Cleveland Clinic tradition of excellence in patient care, research and medical education. We offer multidisciplinary care for patients across the spectrum of Chronic Kidney Disease, as well as management of all aspects of End Stage Renal Failure, including hemodialy- sis, peritoneal dialysis and pre and post op Renal Transplantation care. Our Critical Care Nephrology Service is comprehensive and includes continuous dialysis therapies and plasmapheresis. Our department also specializes in the evaluation and treatment of hypertension and can offer our patients Ambulatory Blood Pressure monitoring when indicated. In addition to providing competent and compassionate clinical care, we are actively engaged in undergraduate and postgraduate medical training, and clinical research. We are pleased to present a review of the services we offer in the Department, as well as data on our outcome, quality and patient satisfaction measures. Dianne Sandy M.D. Chair, Department of Nephrology
  5. 5. Department Overview 2008 and Services Offered The Department of Nephrology and Hypertension Nephrology Outpatient Clinic at Cleveland Clinic Florida is dedicated to providing excellent clinical care and achieving excellent Our Nephrology Outpatient Clinic accepts referrals patient outcomes in all aspects of Clinical from within the Cleveland Clinic System, and from Nephrology including: outside physicians for evaluation and management of the CKD patient. We employ a multidisciplinary • Management of all stages of Chronic Kidney approach to the disease, including our nephrolo- Disease gists, nurse practitioner, nutritionist, social worker • Dialysis and plasmapheresis and nurse educators in the management of all • Renal transplantation aspects of CKD, according to the guidelines outlined • Hypertension by KDOQI. • Renal Stone Disease • General Nephrology including glomerular and KDOQI: Kidney Disease Outcomes and Quality Initiative: interstitial diseases Founded in 1997 to provide evidence based clinical prac- tice guidelines for all stages of chronic kidney disease We are pleased to provide information on the services that we offer in the department and to share our The KDOQI guidelines provide comprehensive objec- quality and outcome data. tives and standards of care in all aspects of CKD. The use of the Electronic Medical Record (EMR) in Chronic Kidney Disease our outpatient clinic facilitates accurate tracking of these patient care parameters and provides a data- Chronic Kidney Disease (CKD) is a major public base from which we can enroll patients for clinical health concern. In the United States, there are research. approximately 20 million adults who have CKD, and another 20 million are at risk for developing this The following parameters are measured and used to condition.The increased incidence and prevalence of evaluate our CKD patients: CKD is intricately linked to the epidemic of chronic diseases like diabetes and hypertension. It has been • Assessment of eGFR, creatinine and rate of shown that early identification and appropriate treat- disease progression ment of patients with CKD decreases the rate of • Control of hypertension progression to End Stage Renal Disease, and affects • Anemia evaluation and treatment cardiovascular morbidity and mortality. • Metabolic bone disease • Hyperlipidemia: identification and treatment • Nutrition • Diabetes: glycemic control and management of complications • Renal replacement therapy preparation including vascular access and transplant evaluation • CKD education and counseling Our patients are encouraged to be active partici- pants in the management of their chronic kidney disease, and have access to their medical data through the the Cleveland Clinic MyChart system. Here, patients can review their laboratory tests and imaging studies, make appointments, order medica- tion refills and communicate with their physician. In addition, our patients are seen regularly in the office and can access the services of our multidisciplinary team when needed.
  6. 6. Department Overview 2008 and Services Offered Outpatient Dialysis Kidney Transplant Our Department is proud of the high quality of Renal transplant has been an integral part of our service we provide for our chronic dialysis patients. Nephrology services. Under the leadership of our We are primary nephrologists for patients in several transplant nephrologist, Dr.Beth Fromkin, our servi- dialysis facilities in Broward County. Our main outpa- ces include comprehensive management of pre and tient facility, however, is the DaVita Weston Dialysis post transplant care. Our department has developed Center where Dr. Mauro Braun serves as Medical a unique transplant collaboration with the Nephrol- Director. In addition to incenter hemodialysis, our ogy and Transplant teams from CCF in Ohio. Surgi- patients are also offered home hemodialysis or peri- cal kidney transplant is not currently performed at toneal dialysis, so that the dialysis modality is best Cleveland Clinic Florida. For this reason, patients suited to their lifestyle and needs. are initially seen by our staff here, where all the pre operative evaluations are performed, and then may For several years, our dialysis center has significant- be referred to the Renal transplant team for their ly exceeded national averages with regard to pa- operation at CCF in Ohio. tient quality of care, as indicated by both the Clini- cal Performance Measures Report published in 2006 The number of renal transplants performed at by the Centers for Medicare and Medicaid Services Cleveland Clinic’s main Ohio campus continues to (CMS), and the March 2007 Fistula First Vascular increase, and over the past five years, data from Access Improvement initiative. more than 600 kidney transplants demonstrate 95% patient survival and >90% allograft survival at one CMS Clinical Performance Measures are a set of year. nationally recognized, evidence-based, performance standards that focus on four key areas of quality kid- ney care: Dialysis adequacy (Kt/V), vascular access type, anemia management (blood Hemoglobin), and nutrition (serum albumin). Patients receiving dialysis under our supervision and care at CCF have a significantly lower mortality risk than the national average. Hypertension Our department specializes in the evaluation and management of patients with poorly controlled or refractory hypertension. We have particular interest in secondary forms of HTN including renovascular hypertension, primary aldosteronism , pheochromo- cytoma, and renal parenchymal disease. The incidence and prevalence of hypertension in- creases with age, and despite greater awareness of the disease, only 60-70% of hypertensive patients are on treatment and only 30-40% are controlled.
  7. 7. Department Overview 2008 and Services Offered Our Department offers: • Open and easy access to our hypertension specialist clinic • Comprehensive evaluation for secondary causes of hypertension • Close follow up with sequential visits until BP is at target • Patient education and support groups • Dietary and nutritional services • Ambulatory BP monitoring 24 hour blood pressure ambulatory monitoring Renal Pathology Our Department offers 24 hour ambulatory blood pressure monitoring. This tool provides a profile of Our Department performs percutaneous renal biop- the patient’s blood pressure away from the medical sies for the diagnosis of glomerular and interstitial environment. It is useful in the diagnosis of “white diseases in native kidneys, and for diagnosis of coat” or office hypertension, to assess the effective- kidney transplant pathology. ness of a patient’s antihypertensive drug regimen, The biopsies are done in the Radiology Department and to detect abnormal patterns of blood pressure. under ultrasound guidance, and we usually require Ambulatory blood pressure monitoring has been that the patient stay overnight for observation shown to be a better predictor of cardiovascular risk than conventional methods of BP monitoring. Dr. Mariana Berho, our renal pathologist, provides expert and timely diagnosis usually within 24-48 hrs of the procedure, so that the patients can be treated promptly. The number of renal transplants performed at Cleveland Clinic’s main Ohio campus continues to increase, and over the past five years, data from more than 600 kidney transplants demonstrate 95% patient survival and >90% allograft survival at one year. We are pleased to offer this service at our outpatient clinic. This discreet, portable device is fitted by our nursing staff and worn by the patient for 24 hrs. Once the monitor is returned, our staff physicians interpret the readings and can provide a detailed report usually within 24-48 hrs. This report often re- sults in a change in the management of the patient’s hypertension. At CCF Florida, we have performed over 400 of these studies to date.
  8. 8. 2008 Innovation Nephrology Fellowship • Our Nephrology Fellowship Program is a two-year ACGME accredited program. • Under the supervision of Dr Mauro Braun, the training program is designed to train highly competent clinical Nephrologists. • Currently, we train one Nephrology Fellow per year. • Our Nephrology Fellows have very close interaction with the staff nephrologists, and ample opportunity for clinical exposure and experience. • First Year Rotations: - Consulting Nephrology Service - Outpatient Dialysis Service - Ambulatory Nephrology - Renal Pathology - Interventional Nephrology • Second Year Rotations - Transplant Nephrology at Cleveland Clinic Ohio - Electives - Research • Weekly Didactic Conferences: Core Curriculum • Journal Club • Renal Pathology Conference • Morbidity and Mortality Conference • 100% pass rate in the ABIM Nephrology Subspecialty Board Examinations.
  9. 9. 2008 Provider Excellence