Project Guidelines

ESRD Networks are tasked by the Centers for Medicare & Medicaid Services (CMS) to support your facility’s goals in providing safe, effective, efficient, patient-centered, timely, and equitable care. Increasing the number of patients receiving dialysis via arteriovenous fistulas (AVF) and reducing long-term catheter (LTC) use for dialysis access is key to providing optimum care for your patients.

A dialysis patient is identified as having a LTC when he or she has been dialyzed with a catheter for 90 days or longer, regardless of whether the catheter has been replaced.

We want to help you to continue to deliver excellent care to your patients and to meet these important goals.

These efforts:
Result in improved patient care;
Minimize loss of revenue due to hospitalizations related to catheter complications;
Help ensure that your facility receives maximum reimbursement through the Quality Incentive Program;
Improve your facility’s rating on the Dialysis Facility Compare website.

Criteria:

  • Each hemodialysis facility’s LTC rate should be less than or equal to 10%. (Network QIA Focus)
  • Each hemodialysis facility’s AVF rate should be equal to or greater than 68%

    If your facility has a LTC rate above 10% as of September 2016 you are required to participate in the Network’s Vascular Access Quality Improvement Activity, which runs throughout the year, with an end date for this year’s activity of September of 2017.

AIM: To decrease rates of long-term catheters (LTC) use (catheters in use for equal to or less than 90%) among prevalent patients by 2%

Baseline: First and second quarter of 2016 (January through June 2016) to re-measure in September 2017 based on first and second quarter of 2017 (December 2016 through May 2017)

Goal and Timeline: The goal of this project is to decrease the Long Term catheter rates in the target facilities by 2% with an optimal goal of less than or equal to a 10% LTC rate in each clinic.

Project Timeline (January 2016- September 2017)

December 2016
The Network notified selected facilities of their participation in the project.

January
Kick-off webinar January 12, 2017. The webinar introduced the project expectations and provided an overview of the tracking and reporting tools for the project. Included in this instructional webinar was the use of an electronic reporting tool for Root Cause Analysis (RCA) and Corrective Action Plan (CAP) to identify barriers for patients having LTC’s. Slides
Reporting: Facilities were required to complete a an RCA/CAP by January 30, 2017.

February
Network staff distributed the tools and provided guidance on the use of the Vascular Access Planning Guide (PDF in English or Spanish) and the Vascular Access Planning Timeline Tracker (VAP) to follow the patient through the eight (8) steps to catheter freedom.
Reporting: Monthly online reporting of facility LTC rates using VAP Tracker data. (February through the end of September)  Recruiting Patient Peer Mentors: Facility staff are asked to recruit patients to train as vascular access Peer Mentors
Monthly Article Review: Network initiated the distribution of a monthly article to facilities with a 5 Question Posttest.

March – Hemodialysis Catheter-Related Infection
Recruiting for the Vascular Access Surgeon Task Force: a group to discuss the barriers and challenges facility staff encounter in developing a vascular access plan for their patients.
Article Review: The Network will provide an article outlining the best approach to prevent hemodialysis infections: Avoid the use of a catheter for dialysis therapy.
Reporting: Monthly Collection Tool

April – Quality Approach to reducing Vascular Access Infections
Article Review: A focus on the quality approach to reducing infection and improve patient outcomes is for removal of the hemodialysis catheter and the access of choice to be an arteriovenous fistula or arteriovenous graft.
Webinar: 2017 LTC QIA conference call/webinar for all facilities in the LTC QIA.
Peer Mentor Training: Network Staff will host Module 1 “Talking effectively with Another Patient.”
Reporting: Monthly Collection Tool

May – Central Venous Catheters: The Good, the Bad and the Ugly
Article Review: Presenting the pros and cons of hemodialysis catheters along with the various complications and excessive economical cost with their use.
Peer Mentor Training: Network Staff will host Module 2 “Mentoring to Support Choices”.
Peer Mentor Training: Network Staff will host Module 3B “ Helping Patients Plan for a Vascular Access”
Reporting: Monthly Collection Tool

June – Catheter –Related Bloodstream Infection and Elderly Patients
Article Review: Focus on the risk of catheter–related bloodstream infection in this population and the challenges faced in developing an access plan.
July - Development and Implementation of a Tracking Tool to Improve AVF rates and Patient Outcomes
Article Review: Benefits of using an Access Tracking Tool to improve fistula/graft rates and improve patient outcomes.
Webinar: 2017 LTC QIA conference call/webinar for all facilities in the LTC QIA.
Reporting: Monthly Collection Tool

August – Development of a systematic approach in identifying the barriers to timely and successful placement of a vascular access
Article Review: Focus on access placement and identifying breakdowns in communication between patients and their care partners and the development of a process to address the barriers with an individualized plan of care.
Reporting: Monthly Collection Tool

September – A Systematic Review of Hemodialysis Access Type and Clinical Outcomes
Article Review: Reviewing the clinical outcomes as the AVF is the recommended vascular access for hemodialysis based on data identifying hemodialysis catheters and highest rates of morbidity and mortality.
Reporting: Monthly Collection Tool

October – 2017 QIA Wrap-up
Network staff will review FFCL reports provided by the ESRD NCC to identify facilities that meet the CMS goal of 2% reduction in LTC rates.
Reporting: Monthly Collection Tool (due to the Network by October 31, 2017)
Notification: Network staff will notify all facilities of graduation or continuance into 2018 LTC QIA project after review of the facility's October reporting data.

patient dialysis access

For more information:

Wambui Kungu
Quality Improvement Coordinator
919-463-4506
wkungu@nw6.esrd.net

Michelle Lewis
Quality Improvement Data Coordinator
919-463-4510
mlewis@nw6.esrd.net