New Campaign Seeks to Reduce Mortality for First-Year Dialysis Patients

Victorian, Brande

doi: 10.1097/01.NEP.0000358534.93938.6b

A coalition of patient advocates, nephrology professionals, and manufacturers has launched a new campaign pledging to slash mortality rates among first-year dialysis patients 20% by the year 2012.

Led by Kidney Care Partners (KCP), the quality improvement initiative, called PEAK (Performance Excellence and Accountability in Kidney Care), is bringing together experts in the nephrology community to improve care for this segment of the kidney disease population. Research partners at Brown University and Quality Partners of Rhode Island are also providing support.

“The campaign is just a means to recognize what the entire renal community feels,” said Edward Jones, MD, President of the Renal Physicians Association (RPA), which is a KCP member organization, in a phone interview.

“We need to approach the delivery of care differently, particularly with dialysis patients, who have a very high first-year mortality rate despite the good that we've been doing over the years. …

“The industry has been working hard, and the RPA has been actively involved with quality performance for a number of years. Approaches to things like this dealing with mortality are a real challenge. We are taking on probably one of the biggest challenges there is in delivering quality care to patients with end-stage renal disease.”

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‘Aggressive Goal’

Reducing mortality by 20% in the next three years would save “thousands and thousands” of lives, said KCP Chair Kent Thiry in a phone interview.

“We wanted to have an aggressive goal because that would force people to really consider doing things differently. If you had a more conservative goal that you were more comfortable about achieving, you'd be too comfortable sticking more or less with what you do now,” said Mr. Thiry, who is Chairman and CEO of DaVita, Inc., another KCP member.

“Once you have that aggressive goal that is going to provoke aggressive thinking, you need to make sure there is time to do the thinking, to experiment—to find out what works—and then to spread the good word about what works and get that implemented.

“That takes time, and so putting all of that together—bold goal, aggressive thinking, and time to experiment and share—meant that the end of 2012 was the amount of time it was going to take to give us a chance.”

The focus of the campaign is to supply health care providers with tools to help first-year dialysis patients better transition into therapy and to improve their overall health and survival, with the additional intended effects of a reduction in hospitalizations and Medicare savings.

While the specifics are still being determined, there are several areas of opportunity, Mr. Thiry noted.

“One is increasing the amount of patient education in those early months where we've found that patient retention is more spotty, the second is increased involvement with families in education, the third is more frequent care plans, and the fourth is tools that are more focused on some of the issues that incident patients face, particularly in the areas of albumin, access, adequacy, and anemia. Those are…specific areas where we've found that by doing more or doing things differently we can make a big difference.”

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Drawing on Organizational Expertise

All 33 KCP member organizations have signed on to be part of PEAK, and the coalition is also inviting non-members to join the campaign.

“[P]art of our excitement and the genesis of this idea is that a number of organizations, including DaVita, have done programs focused on incident patients,” Mr. Thiry said.

Such programs like IMPACT (Incident Management of Patients, Actions Centered on Treatment) from DaVita and RightStart from Fresenius Medical Care— initiatives centered on patient education and management of key clinical outcomes during the first 90 days of dialysis—have resulted in reduced mortality among the patient populations studied and will likely be incorporated into the PEAK campaign on a larger scale.

“How we're going to deal with PEAK will largely grow from the RightStart work we did,” said Kathleen T. Smith, RN, BS, CNN, Vice President for Governmental Affairs with Fresenius Medical Care North America, in a phone interview.

The American Kidney Fund (AKF), an organization that provides financial assistance to approximately 75,000 patients with kidney disease, plans to extend its role in helping patients with end-stage renal disease (ESRD) pay health insurance premiums and maintain access to medical care, as well as spread the word about PEAK.

“We will link to the PEAK Web site, and we will include information on PEAK in our many publications,” said AKF President and CEO LaVarne A. Burton in a phone interview.

“We want to help get out the information, make sure that people are aware of PEAK, and make them aware of where they can go to access the learning center and get information that will help them serve patients even better than they already are, and to help patients obtain information as well.”

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Sharing Best Practices

Kidney Care Partners is currently working with the Centers for Medicare and Medicaid Services (CMS) to develop a database for accurately measuring indicators of improvement so that the campaign's progress can be properly assessed.

Interim reporting will be part of the campaign, but the schedule won't be finalized until CMS determines how frequently it can provide data. The coalition is also putting together expert panels to tackle each area of improvement.

“When you look at some of the demonstrations that have been conducted, it's been shown that we can make significant increases in survival rates, and that has been done when you focus on this initial entry into dialysis,” Ms. Burton said.

“We want to take those best practices that we've learned through demonstrations and other practices and share them throughout the community so that all patients are able to benefit from them.”

© 2009 Lippincott Williams & Wilkins, Inc.