December 28, 2011
2011: Great Strides for Patients – The Best is Yet to Come
This is the time of year to reflect on the past 12 months, to be introspective and honestly assess where we have come and where we are going. As the themes of my blogs over the year have emphasized, patients with kidney disease are among the sickest of the sick, yet are embedded in a system of care that is largely dysfunctional. Uncoordinated care, inadequate focus on care transitions, lack of identification and management of co-morbid conditions, and too little preventive care all remain problems that must be overcome if we are to truly improve survival and quality of life for our patients.
Having said this, however, 2011 also showed us that there is clearly a growing momentum to do things differently, to restructure the way we think about and deliver care, and patients benefit. The one renal community initiative – PEAK, a program to lower incident patient mortality by 20% by the end of 2012 – is on track. The results of the CMS Global Capitation Demonstration Project are in and overall, with an intense focus on care coordination, survival improved, hospitalizations decreased and total costs of care were lower than in a matched group of Medicare fee-for-service population. Both DaVita and FMC identified the key drivers of poor outcomes and created customized programs including provision of nutritional supplements, use of biometric devices to control fluid overload, dramatic success with influenza and pneumococcal vaccination, and medication management therapy, among many others. These programs had one important characteristic in common – they were patient-centric, engaging patients in their own care and being sensitive to what each patient needed and wanted. Outside of the Demonstration, 2011 also saw a significant growth in home dialysis, particularly peritoneal dialysis, again demonstrating a sensitivity to patient needs and desires.
So why am I optimistic about 2012? We now have a large number of approaches to improving outcomes that we know can work and are implementable. In addition, we are continuing discussions with the Center for Medicare and Medicaid Innovation (CMMI) and it looks more and more likely that a large-scale pilot program of integrated care management/care coordination will begin in the New Year. Finally, in mid-2011, a group of Chief Medical Officers from throughout the dialysis industry met together for the first time to discuss ways of substantially moving the quality needle for ESRD patients. This group is working closely with the KCP and KCC, ensuring alignment between business leaders and clinical leaders in the industry, along with policy makers. We have not seen this level of collaboration before and I am confident that 2012 will be just the beginning of new progress to improve the lives of patients with kidney disease. By working together, along with our patients, we can make this happen.
We would all do well to remember the words of Steve Jobs and try to live them as we start the new year:
“Everyone here has the sense that right now is one of those moments when we are influencing the future.”
I look forward to your comments, until next time.
Striving to bring quality to life,
Allen R. Nissenson, MD
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Roberta Mikles BA RN said,
January 10, 2012 @ 7:49 am
In all due respect, as a Dialysis Patient Safety Advocate, I wish that all staff, including physicians, were adequately trained in fully understanding what the dialysis patient experiences, during treatment and away from treatment. Recently, having spoken to a dialysis technician, who only confirmed my thinking of inadequate training/education, I plead with providers to take a deeper look into their training programs. When a non-medical individual enters into the world of dialysis, then is coupled with a preceptor (another dialysis technician), this is not always the best avenue for training. The preceptor, as I am told often, is (a) too busy to answer questions, (b) too busy to observe the new technician and (c) might pass on shortcuts and/or bad habits of care (e.g.infection control practices). I, further, plead with providers to educate so there is less retaliation which is alive in many units, either on a covert or overt level. A simple eye rolling movement, shake/nod of a staff’s head, a facial expression or any gesture sends a message to the patient ‘don’t ever ask me again’.. Additionally, and finally, I plead for patients to be active participants in their care, not just on paper, but in reality. This entails patients being fully educated, encouraged to question staff and ask questions. This would mean that staff (and, physicians) are educated that the patient has a right to question anything being done to their body, and to ask any question that affects them, along with reminding staff, or bringing to their attention a potential or actual error. Staff, and physicians, must understand that an educated patient CAN and often does, prevent mistakes from happening. However, staff, and physicians must be accepting of such, for this is what makes a team, versus labeling a patient a ‘problem’, ‘challenging’, etc..
above opinions are of
Roberta Mikles BA RN
Director, Advocates4QualitySafePatientCare
a nationwide advocacy group non connected to the industry
uncompensated advocates striving for safe, quality care
http://www.qualitysafepatientcare.com