Dialysis Facility Compare (DFC) Website Evaluation ESRD Stakeholders Meeting March 25, 2004 Michael Trisolini, PhD, MBA RTI International
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Dialysis Facility Compare (DFC) Website Evaluation
ESRD Stakeholders Meeting
March 25, 2004
Michael Trisolini, PhD, MBA
RTI International
Presentation outline
1. Project Overview
2. Website Presentation & Navigation
3. Facility Characterisics
4. Quality Measures
5. Dialysis and Kidney Disease Information & Links
6. Next Steps
1. Project overview
Personnel
CMS Project Officer
Eileen Zerhusen, RN, BSN
DFC Evaluation Project Staff
RTIMichael Trisolini, PhD, MBAAmy Roussel, PhDShelly Harris, MPHKaren Bandel, MPHPhilip Salib, BA
MEIDorian Schatell, MSKristi Klicko, BS
Project timetable
Sept. 2002 – Nov. 2002 - Planning, recruiting participants
Dec. 2002 – June 2003 - Qualitative data collection with 6 types of respondents
July 2003 – Oct. 2003 - Reports and recommendations, begin mock-ups of revised DFC
Nov. 2003 – Nov. 2004 - Develop and test mock-ups of revised DFC, develop new content
General objectives
Gain feedback on current DFC content and features from patients, family members, and professionals
Investigate current patterns of DFC use
Study information needs of potential DFC users
Identify ways to improve the DFC
Qualitative data collection
Focus groups
Triads (small focus groups)
In-person interviews
Telephone interviews
Locations for data collection
Site visits (about 1 week each)
Washington, DC Atlanta Chicago Phoenix
Telephone interviews
Respondent types
Number Dialysis patients & family members 98
Dialysis professionals & technicians 98
Pre-ESRD (CKD) patients & family members 42
Pre-ESRD professionals 8
Senior staff of dialysis chains, MCOs & DMOs 18
Senior staff of national renal organizations 6
Dialysis patients & family
Number Hemodialysis patients 63
Peritoneal dialysis patients 12
Family Members 23
----TOTAL 98
Dialysis professionals & techs
Number Nephrologists 9
Nurses 22
Social workers 29
Dietitians 25
Technicians 9
Renal administrators 4----
TOTAL98
General findings - 1
Few respondents currently using the DFC
HD & pre-ESRD patients pleased to have access to the data on DFC, saw it as relevant, but wanted more data and more user-friendliness
Dialysis family members & PD patients less satisfied
All respondents had many ideas for improvements to DFC
General findings - 2
Dialysis patients perceived to have less choice among facilites when starting, but more later
Variation by site
Pre-ESRD patients & family have many learning needs
Pre-ESRD educational programs are in early stages of development
General findings - 3
Internet access less of a problem than expected
Public reporting of quality data perceived by professionals to have value for quality improvement
MCOs & DMOs saw applications for DFC
CMS perceived as honest broker for dialysis & facility information
RTI Recommendations
Based on findings from research
Currently proposals being evaluated by CMS staff
Implementation now under consideration
2. Website presentation & navigation
Readability
Aim for 5th grade reading level
Settle for 7th – 9th grade reading level
Provide button to increase font size
Reduce density of text
Break long text sections into manageable pieces - “chunking”
Short sentences & paragraphs
Bulleted lists
Columns to limit line length to 30-50 characters
Subheadings
Example – current DFC
Read This: The information in Dialysis Facility Compare should be looked at carefully. Use it with the other information you gather about dialysis facilities as you decide where to get dialysis. You should visit any facility in which you are interested and talk with the dialysis facility staff. You may also want to contact your doctor, local ESRD Network or State Survey Agency for more information before you choose a dialysis facility. The telephone number for the local ESRD Network and State Survey Agency can be found in the Helpful Contacts section of this website.
Revised DFC Mockup
Spanish
Create a Spanish language version of DFC
Use model from Nursing Home Compare
“Vea en Espanol” button on each page in English
“View in English” button on each page in Spanish
Increase non-text content
Graphics, photographs, diagrams, cartoons
Mapping function with “zoom” (like MapQuest)
Animation
Audio clips, video clips
Revised DFC Mockup
Concerns with non-text content
Section 508 – accessibility for visually impaired beneficiaries
Load time
Hardware, software requirements
Reduce scrolling
Add headings with hyperlinks
Add tabs and sub-tabs for results
Revised DFC Mockup
Add user-friendly features for those with little web experience
Tabs or hyperlinks for special populations PD patients Family members CKD patients Pediatric patients and their parents
Clarify context, “why to use DFC”
Revised DFC Mockup
Facility characteristics table
Enable facility characteristics table to show 4-6 facilities per screen versus 2
Reduce font size if needed, with option to switch back to larger font and 2 facilities per screen
3. Facility Characteristics
Current DFC
Participants suggested many new facility characteristics
Patient issues
Staffing issues
Organizational issues
Policy issues
PD patients have special information needs
Number of PD staff
Number of PD patients
PD patients per PD nurse
PD training
PD supplies and equipment
Pre-ESRD patients and family made fewer suggestions
Don’t know enough to know what they need to know
Very interested in the experience of receiving dialysis care
Patient checklists would be very helpful
Add patient checklists
DFC cannot offer everything
Encourage patients to contact dialysis facilities and providers with specific questions
Provide detailed list of potential areas of inquiry
Consider facility characteristics from SIMS database
Review available data elements
Add relevant facility characteristics
Consider information on state surveys and inspections
Follows Nursing Home Compare (CMS exploring similar approach for DFC)
Most recent Medicare certification (initial certification date already posted on DFC)
Most recent state survey date
Deficiencies cited
Add to checklist
Information on amenities
Topics highlighted by respondents: Support groups Visitor policy Accessibility for people with disabilities Televisions Data ports Cleanliness
Add to checklist
Information on scheduling
Shift times
Hours and days of operation
Add to checklist
Offer more information about modalities
Availability
How many patients are receiving various modalities
Add to checklist
Staffing information
Staffing ratios
Certification or training of technicians
Number staff on site
Clinical staff availability
Add to checklist
Revised DFC Mockup
3. Quality measures
3. Quality measures
Adequacy & Anemia
Presentation – very appealing
Colored bar graphs
Comparisons to national & state averages
Multiple facility comparisons
Content
Patients & family members liked comparing facilities
Kt/V & hemoglobin preferred by professionals
But URR & hematocrit considered acceptable
Professionals had some casemix concerns
Age of the quality data was not a major concern for patients & family members, but was for professionals
Text explanations – problematic
Glossary definitions too complicated, too long
Explanations above the bar graphs better, but not great
Reading level too high
Too much text – patients & family usually skip over it
3. Quality measures
Patient survival
Patients & family
Statistical language hard to understand – “better than expected”
Explanation above the results table unclear to many
FAQs better
Most prefer bar graphs (adequacy & anemia) to the check marks in the patient survival results table
Most still wanted to see survival data
Professionals
Concern that non-facility factors affect survival Percent elderly & nursing home residents Percent poor nutrition or non-compliant Percent comorbidities
Some understood existing casemix adjustments (age, race, gender, diabetes) but many missed it
Also liked FAQs
Suggested text explanations too complex for patients & family
3. Quality measures
Recommendations
General
Add (a few) more quality measures
Consider PD-specific quality measures
Replace “Not Available” with specific reasons
Current DFC
Revised DFC Mockup
Presentation
Revise text explanations
Reduce amount of text
Highlight links to FAQs & expand them
Lower reading level
More use of non-text methods – diagrams, pictures, graphics
Consider presenting quality data as trends over time
Recommendations for new measures - 1
Patient satisfaction (experience of care)
STRONG preference of patients (they want to
hear from other patients)
A way to have their “voice” heard
Also supported by professionals
Most dialysis facilities already collect these data
Recommendations for new measures - 2
Transplant waiting list
Vascular access
State survey results
Recommendations for new measures - PD
PD-only adequacy (Kt/V)
Albumin levels
Recommendations for changing measures
Kt/V versus URR
Hemoglobin versus hematocrit
Follow Clinical Performance Measures
Most facilities already collect these data
5. Dialysis and kidney disease information & links
Uses of DFC for patient education
Patients would like more information on a range of topics
Professionals saw potential for use in educating patients
CKD educators could add to their resource lists and classroom exercises
Currently limited applicability to PD patients
Additional information sought - 1
Patient experience of treatment. E.g., “What’s it like to be on PD?”
Information on clinical aspects of dialysis & renal disease
Information on dialysis and CKD self-care (e.g., nutrition, vascular access)
Additional information sought - 2
More on transplantation
More on PD
Explanations of medical terms (e.g., “necrotic”)
Meaning of lab results – link to quality measures
Implications of patient non-adherence to treatment
Rights and responsibilities of patients
Develop checklists for patients
Reinforce message that patients should seek information from facilities and providers directly
Patients often don’t know what to ask
Support patient involvement in decision-making and in managing their own care
Make Web links more prominent and more extensive
Other federal and state resources
Renal organizations
External information sources
Patient education resources
Consider special needs of new dialysis and CKD patients
Would like better understanding of kidney function and renal disease
Adjusting to dietary changes
Facing choices: how to delay need for dialysis vascular access dialysis modality transplant dialysis facility
Consider information needs of other special populations
PD patients
Family members
Pediatric patients & their parents
Non-English-speaking patients
6. Next Steps
Questions & comments
Comment form in conference notebooks
Microphones in aisles
RTI Next Steps
Assist development of Next Generation DFC
Test new language and text
Develop and test checklists
Plan additional revisions to DFC
CMS Next Steps
Consider additional quality measures for public reporting
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