Coalition offers broad framework to improve kidney care

A coalition of patient advocates, dialysis-care providers and manufacturers today will unveil a comprehensive new framework for kidney care across the country that identifies four goals: improve survival, reduce hospitalizations, improve health-related quality of life, and improve patient experience with care.

Kidney Care Partners—established in 2003 to improve care for people with chronic kidney disease—will release A Strategic Blueprint for Advancing Kidney Care Quality (PDF), after more than a year of work on the ambitious plan. The blueprint will also be the focus of a webinar on world kidney day on March 13.

The blueprint cites data from the U.S. Renal Data System that roughly 615,000 adults and about 9,000 children lived with end-stage renal disease in 2011 and required either dialysis or a transplant to survive. While there have been recent improvements in kidney care, members of Kidney Care Partners thought more needed to be done. At a meeting roughly two years ago, members discussed ways to drive quality in this segment and determined they needed to step back and establish priorities.

“There was a strong feeling that we still need to respond to what CMS does, but we need to be proactive, rather than reactive,” said Dr. Allen Nissenson, chief medical officer of DaVita HealthCare Partners and an emeritus professor of medicine at the David Geffen School of Medicine at UCLA.

“Let's look at what experienced clinicians and patients believe was the intent of the program and where it needs to go,” he said, referring to Medicare's end-stage renal disease program that was established in 1973. “And then hopefully we can get CMS more informed.” Nissenson also is a member of the KCP Blueprint Steering Committee.

To that end, KCP identified nine “domains” for kidney-care quality in the blueprint—the key areas needed to make an impact on the blueprint's four overarching goals. The group also identified 32 “strategic opportunities” to improve kidney care quality. The domains include care coordination; disease management; infrastructure; palliative and end-of-life care; patient engagement and education; patient satisfaction and experience with care; pediatric-specific issues; quality of life; and safety.

The next step will be to prioritize the domains, according to Dr. Edward Jones, a nephrologist with Delaware Valley Nephrology and Hypertension Associates in Philadelphia and also a member of the KCP Blueprint Steering Committee.

Jones and Nissenson, also a nephrologist, explain that work groups composed of clinical and methodology experts will then develop measures within the specific domains, which would work toward the blueprint's four goals. Ultimately, the aim is to develop measures that will be endorsed by the National Quality Forum and eventually adopted by the CMS, according to Nissenson.

Jones, who serves on the board of directors of the Renal Physicians Association and is the newly elected chairman of Kidney Care Partners (a role he also held from 2007-08), plans to discuss the blueprint with about 22 CMOs who represent the majority of the nation's dialysis centers this month. He also said that after KCP prioritizes the top two domains, it will then work to develop two measures within each of those two categories, which he estimates will take about 18 months. Other measures will follow.

“If we are responsible for care,” Jones said, “we want to be involved in the metrics that define that care.”

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