F3: "Fistula Interventions: An Awareness-driven Approach" - No ...


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F3: "Fistula Interventions: An Awareness-driven Approach" - No ...

  1. 1. Alyssa Chase, MHA Core Prevention Manager Q-Source, TN’s QIO May 6, 2010 “ Fistula Interventions: An Awareness-driven Approach”
  2. 2. TN Diabetes Facts 2007 <ul><li>Prevalence </li></ul><ul><ul><li>2008 - Statewide rate 10.9% /higher than national rate of 8% </li></ul></ul><ul><ul><li>2007 - 517,000 adults diagnosed w/Type 2 </li></ul></ul><ul><ul><li>2006 - 480,000 adults diagnosed w/Type 2 </li></ul></ul><ul><li>Mortality </li></ul><ul><ul><li>1,827 deaths related to DM between 2002 – 2004, a 92% increase over 1990- 1992 </li></ul></ul><ul><li>Hospitalizations </li></ul><ul><ul><li>8,995 inpatients on average per year w/principal diagnosis of DM </li></ul></ul><ul><li>Diabetic End Stage Renal Disease Incidence </li></ul><ul><li>1990 – 349 new cases of DM-related ESRD </li></ul><ul><ul><ul><li>2003 – 928 new cases of DM-related ESRD </li></ul></ul></ul>Sources: Tennessee Behavioral Risk Factor Surveillance Survey (BRFSS), 2007, TN Dept. of Health, Tennessee Hospital Discharge Data System (HDDS), and U.S. End Stage Renal Data System (USRDS)
  3. 3. In Tennessee July 2008 - June 2009 <ul><ul><li>Total Medicare Beneficiaries = 1,055,178 </li></ul></ul><ul><ul><li>Total Diabetic Medicare Beneficiaries = 150, 155 </li></ul></ul><ul><ul><li>Total Hypertensive Medicare Beneficiaries = 264,687 </li></ul></ul><ul><ul><li>Total CKD Medicare Beneficiaries = 22,254 </li></ul></ul>
  4. 4. Cost of CKD to the Medicare Fund 2006– CKD costs comprised 22.1% of general Medicare costs --(CMS data)
  5. 5. Estimated Costs for CKD in the Medicare/Medicaid population, by State, 2005 TN 2007 USRDS
  6. 6. 2007 USRDS ADR Costs of the ESRD & Medicare Programs
  7. 7. Goals of the CKD initiative <ul><ul><li>Decrease the incidence of CKD among diabetic patients </li></ul></ul><ul><ul><li>Slow progressing of CKD through </li></ul></ul><ul><li>early intervention </li></ul><ul><ul><li>Encourage timely counseling for Renal Replacement Therapy (RRT) </li></ul></ul><ul><ul><li>Promote fistula placement and maturation as first choice for access where medically appropriate </li></ul></ul>
  8. 8. CKD Project Measures <ul><ul><li>Increase CKD screening in Medicare </li></ul></ul><ul><li>patients with diabetes (annual microalbumin screening) </li></ul><ul><ul><li>Increase use of ACEI/ARBS in CKD patients with diabetes </li></ul></ul><ul><ul><li>Increase Use of AV fistulas for dialysis </li></ul></ul><ul><ul><li>Increase participation in PQRI for CKD/Diabetes </li></ul></ul><ul><ul><li>Increase use of Computerized records for CKD care management </li></ul></ul>
  9. 9. Benefits to Patients Early detection and treatment means delayed disease progression AV fistula as first choice for hemodialysis means fewer access complications
  10. 10. Providers Involved
  11. 11. Providers Involved
  12. 12. Focus counties in Tennessee, selected based on Medicare claims data, 2007 Shelby – 14,313 diabetic beneficiaries Davidson – 8,144 diabetic beneficiaries Hamilton – 6,936 diabetic beneficiaries Knox – 6,847 diabetic beneficiaries (auxiliary areas also if resources allow)
  13. 14. Medicare Beneficiaries with CKD in Tennessee, by Stage July 2008 - June 2009
  14. 15. CKD Medicare Benes per County Top 10 Counties: July 2008 - June 2009 # CKD Any Stage/# Medicare Benes in County
  15. 16. Interventions <ul><ul><li>Systems Changes: </li></ul></ul><ul><ul><li>Save Your Veins </li></ul></ul><ul><ul><li>Exercise Your Fistula Toolkits </li></ul></ul><ul><ul><li>Dialysis CKD Educators </li></ul></ul><ul><ul><li>Opt-out Referrals </li></ul></ul><ul><ul><li>“ Accessories”: </li></ul></ul><ul><ul><li>Nephrology/Vascular Surgeon Focus Groups </li></ul></ul><ul><ul><li>Fistula First Coalitions </li></ul></ul><ul><ul><li>Referrals from Nephrologists </li></ul></ul><ul><ul><li>RPA Vascular Passports </li></ul></ul>
  16. 17. Save Your Veins
  17. 18. SYV Pilot Testing <ul><li>Posters </li></ul><ul><li>Patient Comments: </li></ul><ul><ul><li>&quot;I wont take it off“ </li></ul></ul><ul><ul><li>&quot;It's a good thing“ </li></ul></ul><ul><ul><li>&quot;I want diamonds in it, but I guess I will wear it“ </li></ul></ul><ul><ul><li>&quot;Great Idea&quot; (wife of patient) </li></ul></ul><ul><li>ED Staff </li></ul><ul><li>EMT/Firemen </li></ul><ul><li>Nephrology vs. Vascular Surgery (FFBI) </li></ul>
  18. 19. Exercise Your Fistula
  19. 20. Interventions <ul><ul><li>Systems Changes: </li></ul></ul><ul><ul><li>Save Your Veins </li></ul></ul><ul><ul><li>Exercise Your Fistula Toolkits </li></ul></ul><ul><ul><li>Dialysis CKD Educators </li></ul></ul><ul><ul><li>Opt-out Referrals </li></ul></ul>
  20. 23. Interventions <ul><ul><li>“ Accessories”: </li></ul></ul><ul><ul><li>Nephrology/Vascular Surgeon Focus Groups </li></ul></ul><ul><ul><li>Fistula First Coalitions </li></ul></ul><ul><ul><li>RPA Vascular Passports </li></ul></ul><ul><ul><li>Cannulation Camps </li></ul></ul><ul><ul><li>AAKP “Kidney Beginnings Live!” </li></ul></ul>
  21. 24. How Are We Doing?
  22. 25. Memphis Fistula Data Data Courteousy of Network 8
  23. 26. Effectiveness & Sustainability <ul><li>Data </li></ul><ul><li>Patient-level Outcomes </li></ul><ul><li>Literature/evidence based </li></ul><ul><li>Spread within QIO community and national </li></ul><ul><li>Awareness plus tangible interventions </li></ul>
  24. 27. Where Do We Go From Here <ul><li>Fistulas placed 6 to 12 months prior to requiring hemodialysis </li></ul><ul><li>Identify other best practices for upcoming 10SoW </li></ul>
  25. 28. Questions and Comments? This material was prepared by QSource, The Medicare Quality Improvement Organization (QIO) for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (CHHS). This content presented does not necessarily reflect (CMS) policy. QSOURCE- TN-CKD-2008-00009 2007 USRDS ADR – United States Renal Data System (USRDS) Annual Data Report (ADR)
  26. 29. Alyssa Chase, MHA Core Prevention Manager Q-Source, TN’s QIO Stacy Jowers Dorris, MBA, RHIA, CPHQ CKD Program Manager, QSource [email_address]