KIDNEY CARE QUALITY ALLIANCE

Transcription

1 TO: FR: RE: KCQA Members KCQA Steering Committee (Ed Jones, MD-Co-Chair; Allen Nissenson, MD-Co-Chair; Akhtar Ashfaq, MD; Donna Bednarski, RN, MSN; Barbara Fivush, MD; Ray Hakim, MD, PhD; Jay-r Lacson, MD, MPH; Shari Ling, MD-CMS Liaison; Chris Lovell, RN, MSN; Tom Manley, RN, BSN; Gail Wick, MHSA, BSN, RN.) Recommendation for Fluid Management Measure Specifications DA: November 4, 2014 As discussed on our webinar/conference call on October 16, the Feasibility/Testing Workgroup has been working since early September to identify and specify 1-2 fluid management measures for KCQA s consideration, with the goal of submitting measures to the National Quality Forum for endorsement consideration. We have reviewed that work and recommend the following measures for your approval for the next step, which is measure testing: FM2 Post-Dialysis Weight Above or Below Target Weight FM7 Avoidance of Utilization of High UFR (>13 ml/kg/hour) Specifically, the Steering Committee recommends retrospective testing of FM2 and FM7 to assess the performance gap, validity, and reliability to meet the NQF criterion, as well as prospective testing in a small sample of facilities to identify implementation issues. Detailed specifications for both measures are provided as Attachment A. We urge you approve this next step retrospective and prospective testing for FM2 and FM7 in the KCQA process. Balloting (with an opportunity for accompanying comments) will occur via a surveymonkey link to Lead Representatives following the webinar/call.

2 DRAFT MEASURE SPECIFICATIONS TABLE 10/23/14 ID TITLE DESCRIPTION NUMERATOR DENOMINATOR EXCLUSIONS FM2 Post-Dialysis Weight Above or Below Target Weight Percentage of patients with an average post-dialysis weight >1 kg above or below the prescribed target weight in the reporting month. Number of patients from the denominator with an average postdialysis weight >1 kg above or below the prescribed target weight in the reporting month. Interpretation of Score: Lower score = better quality Number of adult in-center hemodialysis patients in an outpatient dialysis facility undergoing chronic maintenance hemodialysis in the calculation period. 1. Age <18 years. 2. Patients in a facility <30 days. 3. Home dialysis patients. 4. <7 hemodialysis treatments in the facility during the month. 5. Facilities treating <XX adult in-center hemodialysis patients during the reporting month Patients without a completed CMS Medical Evidence Form (Form CMS-2728), FM7 Avoidance of Utilization of High UFR (>13 ml/kg/hour) Percentage of adult in-center hemodialysis patients in the facility whose average UFR >13 ml/kg/hour. Number of patients from the denominator whose average UFR >13 ml/kg/hour who receive an average of <240 minutes per treatment during the calculation period. Interpretation of Score: Lower score = better quality Additional Information: The average UFR is calculated for the treatments received in the calculation period, defined as the same week that the monthly Kt/V is drawn. Number of adult in-center hemodialysis patients in an outpatient dialysis facility undergoing chronic maintenance hemodialysis in the reporting period. 1. Age <18 years. 2. Patients in a facility <30 days. 3. Peritoneal dialysis patients. 4. <7 hemodialysis treatments in the facility during the month. 5. Facilities treating <XX adult in-center hemodialysis patients during the reporting period Patients without a completed CMS Medical Evidence Form (Form CMS-2728), The average UFR for the calculation period is calculated in the following manner: 1. The UFR is first calculated for each treatment in the calculation period as: ([Pre-Dialysis Weight Post-Dialysis Weight {in kg} x 1000 ml/kg] Post-Dialysis Weight {in kg}) (Delivered Treatment Time {in hours to 0.1 based on minutes, as below )) 2. The average UFR for the calculation period is then calculated by summing the UFRs for each treatment and dividing by the number of treatments in the calculation period: (UFR1 + UFR2 + UFRX) (X treatments) The average treatment time is calculated as: (Total Minutes Dialyzed During the Calculation Period) (Number of Treatments in Calculation Period) 1 The Workgroup agreed to empirically determine the appropriate minimum number of patients empirically during testing. KCQA WORKING DOCUMENT

3 All-KCQA Conference Call/Webinar November 7, ; # If you ve dialed in through the computer, please hang up and use this dial-in.

4 ROLL CALL 2

5 OPENING REMARKS Allen Nissenson, MD KCQA Co-Chair 3

6 CALL GROUND RULES Call/webinar is open to public (registration was required) and a public access file of all materials was made available on the web KCQA members participate in agenda items as they arise Specific time is provided on agenda for public comment All remarks are off the record 4

7 AGENDA 1. Review of recommended fluid management measure specifications Last month s call reviewed specifications for FM2 (related to post-dialysis weight) and previewed for you the FM7 concept (related to avoidance of high UFR) This call again presents FM2, but also presents full specifications for FM7 2. Questions from KCQA members on Steering Committee recommendation and/or specifications 3. Next steps and public comment 5

8 STEERING COMMITTEE AND WORKGROUP KCQA Steering Committee: Ed Jones (Co-Chair); Allen Nissenson (Co-Chair); Akhtar Ashfaq; Donna Bednarski; Barbara Fivush; Ray Hakim; Jay-r Lacson; Shari Ling; Chris Lovell; Tom Manley; Gail Wick Testing/Feasibility Workgroup: Scott Bieber; Steven Brunelli (non-voting); Maggie Carey (nonvoting); Joseph Flynn; Lori Hartwell; Jeffrey Hymes; Mahesh Krishnan; Jay-r Lacson (non-voting); Klemens Meyer; Paul Miller; Don Molony; Tom Parker; Glenda Payne; Dan Weiner 6

9 CHARGE FROM STEERING COMMITTEE Identify the top 4-5 measure concepts, and from there measure specifications (numerator, denominator, exclusions), from which KCQA can approve 1-2 related measures for testing for the purpose of submitting to NQF for endorsement. 11

10 STEERING COMMITTEE RECOMMENDATIONS FM2: Post-Dialysis Weight Above or Below Target Weight FM7: Avoidance of Utilization of High UFR (>13 ml/kg/hour) Approve both measures as specified for retrospective testing for performance gap, reliability, and feasibility and prospective testing for implementation issues. 15

11 FM2: Post-Dialysis Weight Above or Below Target Weight 3

12 FM7: Avoidance of Utilization of High UFR (>13 ml/kg/hour) 3

13 NEXT STEPS Survey monkey link to Lead Representatives to vote on Steering Committee s recommendations to approve both measures, as specified, for retrospective and prospective testing Testing measures Workgroup, Steering Committee, and KCQA will review testing results, adjusting specifications if necessary Submit measures to NQF 16

14 PUBLIC COMMENT 17