This sub-national task requires the implementation of CKD disparities reduction activities in each clinical CKD focus-area in which disparities are evident. Education is provided through interventions directed toward primary care practices and other practices that provide services to the priority (formerly known as priority) diabetic population in order to reduce disparities in CKD. QIOs also utilize existing collaborative efforts and develop new mechanisms to support a community effort to effect quality improvement at the system level.
In order to achieve these goals, there are two main tasks for QIOs. The first task is a clinical focus in the following three areas, each with a corresponding clinical measure:
- Early detection of CKD in beneficiaries with diabetes,
- Appropriate medication treatment (angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) to slow the progression of kidney failure), and
- Adequate counseling prior to initiation of dialysis which leads to placement of an arteriovenous (AV) fistula for hemodialysis patients.
The goals of the corresponding clinical measures are to:
- Increase the screening for nephropathy,
- Increase the frequency ACE/ARB therapy used to treat individuals with diabetes and earlier stages of CKD, and
- Increase the rate of individuals starting their first dialysis treatment with a mature AV fistula.
The second task is to use collaboration as a means of achieving sustainable CKD system-level changes. Partners involved will include community health centers, community representatives, ESRD Network Organizations, health department diabetes grantees, local chapters of kidney organizations, patient representatives, provider groups, state and county government representatives, and others.
QIOs engaged in the CKD tasks will be required to successfully pass the established targets in all clinical outcome measures in addition to provider recruitment and partner collaboration goals.
CKD QIOs are supported in their work by the Prevention Quality Improvement Organization Support Center (Prevention QIOSC). VHQC, the Virginia QIO, holds the contract for the Prevention QIOSC, and subcontracts with QSource and SoftDev to provide support to CKD QIOs. Please contact Robin Weil, Prevention QIOSC Director, for more information at rweil@vaqio.sdps.org.
CKD QIO Activities:
Florida: FMQAI formed the statewide Florida Chronic Kidney Disease Coalition, comprising 47 broad-based member organizations. FMQAI is providing physicians with free tools to help facilitate early diagnosis of CKD and evidence-based information for tracking CKD stages with treatment modalities and patient educational materials.
Georgia: The Georgia Medical Care Foundation initiated a CKD Community Coalition that includes a number of partner organizations representing various health disciplines, providers, and patients. A total of 220 healthcare providers are collaborating to effect system-level changes. Participating providers are awarded with American Board of Internal Medicine (ABIM) or American Board of Family Medicine (ABFM) credit for recertification.
Missouri: The Missouri QIO, Primaris, produced a number of tools and information sheets for providers and Medicare Beneficiaries/patients. Physicians and healthcare associations are working to implement system changes to improve the quality of CKD monitoring.
Montana: The Mountain-Pacific Quality Health Foundation co-hosted a conference “Getting There: Pathways to Better and Safer Dialysis” on June 5, 2009. They are partnering with government agencies, state and national organizations, and consumer advocacy groups and are working formally as the Montana Diabetes and CKD Care Partnership.
Nevada: HealthInsight contacted 216 physicians to congratulate them on the high percentage of their Medicare fee-for-service patients receiving appropriate screening to identify early stages of kidney damage. These physicians share insights into how they have achieved screening rates above 88 percent. HealthInsight is sponsoring a conference “Kidney Learning Day a Partnership between Primary Care and Nephrology” in May, 2009.
New York: IPRO, Inc. (IPRO) is partnering with the End Stage Renal Disease (ESRD) Network of New York Fistula First Steering Committee to increase AV-fistula rates, provide a forum for collaboration, and promote the improvement of overall CKD care utilizing the university continuum of care model to support the chronic care model in conjunction with community outreach education.
Rhode Island: Quality Partners has convened an Advisory Panel consisting of clinicians who identify interventions for the 30 participating providers to implement and a Strategic Coalition that collaborates and coordinates resources to effect system-level changes. Quality Partners is developing a Practice Assistance Program based upon the Patient Centered Medical Home (PCMH) model of care and incorporating health information technology as a tool to assist with outcome improvement.
Tennessee: QSource has created a state-wide coalition to conduct a needs assessment and to subsequently convene smaller workgroup(s) within the coalition to address disparities in CKD. Interventions include the "Save the Vein" campaign (patient/provider awareness), Fistula First Surgical Toolkit (patient education), automatic eGFR calculation in hospitals for particular patients, and physician practice interventions including education and resource/tool distribution.
Texas: TMF Health Quality Institute is collaborating with the CKD Task Force, the National Kidney Foundation, ESRD Network 14, Texas Renal Coalition, and DSHS in an initiative to promote improvements in CKD quality measures. TMF created "Diabetes and Kidney Disease: Save Their Kidneys," a free one-hour continuing medical education (CME) presentation offered in the physician office or as a webinar training event and is also actively promoting other educational seminars that cover a range of CKD-related topics.
U.S. Virgin Islands: Virgin Islands Medical Institute (VIMI) monitors the impact that quality interventions have on disparities in care (e.g., ethnic, racial, socio-economic, and geographic), which includes a sufficiently large proportion of the Virgin Islands’ Medicare population (i.e., 85 percent to 90 percent, depending upon the source) to include the entire Territory. VIMI takes rapid corrective action and implements activities to correct and improve the quality of CKD in its Territory.
Utah: HealthInsight is creating a DVD featuring experts, as well as a local doctor who was previously featured on a television news segment, to discuss important elements of diabetic care in short segments. They also produce a monthly Kidney Kronicles information newsletter. |
