The Florida ESRD Network 2014 ANNUAL FORUM: STEP UP TO THE PLATE Hit a Home Run in ESRD Care! Demetra Denmon, MA, WSD ESRD Network 7 Executive Director Jeffrey J. Sands, MD, MMM ESRD Network 7 Board of Directors Chair November 20, 2014 Gaylord Palms Hotel & Convention Center • Kissimmee, FL
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The Florida ESRD Network 2014 ANNUAL FORUM: STEP UP TO THE PLATE Hit a Home Run in ESRD Care! Demetra Denmon, MA, WSD ESRD Network 7 Executive Director.
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The Florida ESRD Network
2014 ANNUAL FORUM:STEP UP TO THE PLATE
Hit a Home Run in ESRD Care!
Demetra Denmon, MA, WSDESRD Network 7 Executive Director
Jeffrey J. Sands, MD, MMMESRD Network 7 Board of Directors Chair
November 20, 2014 Gaylord Palms Hotel & Convention Center • Kissimmee, FL
2The Florida ESRD Network
Today’s Lineup
Top of the Inning • Network 7 Changes• Demographics
Down the Stretch • Mortality• Hospitalization• Vascular Access• Quality Indicators• ESRD Costs
Triple Play• Quality and the Network• Patient and Family Engagement • Learning and Action Network (LAN) Quality Improvement Activities (QIAs) and
Campaigns 11/20/2014
3The Florida ESRD Network
What We Do As the Network
• Oversee the quality of dialysis care• Encourage patients engagement in their ESRD care• Provide technical education and assistance to ESRD
facilities• Assist in the administration of the ESRD program
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4The Florida ESRD Network
ESRD Network Ownership 2014
Data Source: 2013 Network Annual Reports *Transplant Prevalence as of 12/31/2012
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5
Network 7 Changes
Demographics
TOP OF THE INNING
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6The Florida ESRD Network
Network 7 Changes
• Florida Medical Quality Assurance, Inc.(FMQAI) will become Health Services Advisory Group (HSAG)
• July 2014 office moved to 3000 Bayport Drive, Suite 300, Tampa, FL 33607
• Staffing Changes New Executive Director—Demetra Denmon New QID—TBD
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7The Florida ESRD Network
Florida ESRD Demographics
*VR increase from 654 in 2012 appears related to facility usage of CROWNWeb
Source: 2013 ESRD Facility Survey11/20/2014
8The Florida ESRD Network
Florida Prevalence by Race
Source: 2013 ESRD Facility Survey
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9The Florida ESRD Network
Florida Modality Treatments
Source: 2013 ESRD Facility Survey
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DOWN THE STRETCH
Mortality
Hospitalization
Vascular Access
Quality Indicators
ESRD Costs
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11The Florida ESRD Network
National Incident & Prevalent Patient Counts by Modality
Source: USRDS 2013 ADR
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12The Florida ESRD Network
Total Medicare Expenditures Per Person Per Year, by Modality
• Total Medicare ESRD costs from claims data• Includes Medicare as primary claims• Period prevalent ESRD patients
Source: USRDS 2013 ADR
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13The Florida ESRD Network
Mortality in Prevalent Dialysis Patients
• Adjusted all cause mortality rates in period prevalent hemodialysis patients, by vintage
• Adjusted for age, gender, race, and primary diagnosis• Incident hemodialysis patients, 2010, used as reference cohort
<0.01); all cause and cardiovascular hospitalization and mortality
Oral Nutrition Supplement for Alb <3.8 decreased 1 year mortality
• 16.2% (CI 11.8, 20.3) vs 23.4% (21.2, 25.4) in matched CPM sample
CMS Dec 8 201011/20/2014
39The Florida ESRD Network
Reducing Readmission with Nutrition Management
• FMQAI Care Transitions Pilot Project (2010) Provided free meals to elderly patients upon
dischargeo Enrolled seniors received one month of meals and a
nurse’s visito Readmission rate dropped from 23.0% to 2.7%o Meals alone dropped readmission rate by nearly 10.0%
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Source: Beattie, S., & Burrough, B. (2013) Reducing Readmissions with Nutrition Management, Briefing White Paper. PurFoods, LLC/Mom’s Meals NourishCare
40The Florida ESRD Network
Intradialytic hypotension (IH)
• IH is frequent: 17.2% of Tx Varies by patient (0-100% Tx) and dialysis facility (11.1-25% Tx)
• IH frequency correlates with poorer survival, increased hospitalization and hospitalized days
• Both facility and patient characteristics are independent predictors of IH
% Tx with IH
N #TxDeaths/
100 pt yrs
Hospital admissions/
pt yr
Hospital days/pt yr
<1% 123 2460 8.90 1.10 8.90
1-35% 230 46008.9
(p=0.999)1.21
(p=0.47)9.02
(p=0.725)
>35% 93 186022.4
(p=0.036)1.5
(p=0.04)10.84
(p=0.0002)
Total 446 8920 11.69 1.24 9.31
Sands JJ et al; HDI 18:415-422 201411/20/2014
41The Florida ESRD Network
Preventing Brain Injury by Lowering Dialysate Temperature (T)
• 73 incident patients randomized to 37°C dialysate vs dialysate 0.5°C below core body T
• Results 37°C dialysate: Ischemic brain injury on serial MRI imaging Changes in brain white matter associated with hemodynamic
instability (p<0.05) 0.5°C< core body T dialysate: Improved hemodynamic stability and
complete protection against white matter changes at 1 year
• Conclusion “….HD results in significant brain injury and that improvement in
hemodynamic tolerability achieved by using cooled dialysate is effective at abrogating these effects. This intervention can be delivered without additional cost and is universally applicable.”
The Florida ESRD Network3000 Bayport Drive, Suite 300Tampa, FL 33607813-354-9111
It’s a Grand Slam!
11/20/2014
This material was prepared by ESRD Network 7, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy nor imply endorsement by the U.S. Government.FL-ESRD-GR-11142014-01