With six months of data collection remaining, a three-year effort by the renal community to cut first-year mortality among dialysis patients reached 12.3% of a 20% goal, a "pretty substantial" improvement by standards for similar health care initiatives, according to the Brown University data analyst who tracked the Kidney Care Partners initiative.
Kidney Care Partners' PEAK campaign
Kidney Care Partners launched Performance Excellence and Accountability in Kidney Care (PEAK) in June 2009, citing U.S. Renal Data System data showing first-year mortality for individuals starting dialysis was close to 30%, This was in contrast to the improvement seen in the mortality of dialysis patients between two to five years after dialysis initiation, Kidney Care Partners said. The rate mortality rate among dialysis patients in the first year is 33% higher than in Europe and three times higher than in Japan, according to data from a Dialysis Outcomes and Practice Patterns Study.
Renal providers say patients starting dialysis face poor outcomes because of inadequate care prior to kidney failure, underlying comorbid diseases, and less-than-optimal access management (more than 80% of new patients start dialysis in the United States with a temporary catheter).
The PEAK campaign focused on patient education and key clinical care activities to achieve a 20% reduction in first-year mortality over three years and aimed for a goal of saving 10,000 lives. Kidney Care Partners formed committees to develop focus areas of improvement, and the list eventually included case management, nutrition, anemia management, dialysis adequacy, catheter use, and psychological and social support.
PEAK efforts reduce mortality among dialysis patients
The results show a cumulative 12.3% drop in mortality from June 2009 to June 2012; data will be collected through the end of the year and any additional improvement will be reported by the Kidney Care Partners in June 2013.
Brown University, which coordinated the data analysis for PEAK, primarily looked for quantitative changes to dialysis adequacy and vascular access type over the three-year period and linked those changes to the reduction in the mortality rate.
"A reduction of 12.3% is pretty substantial and speaks well for this effort that the kidney community voluntarily challenged itself to do," said Brown's Vincent Mor, PhD, who was part of a data review panel that tracked the results. "According to the data, based on the numbers of new patients with kidney failure in 2010, the decline represents an estimated 3,480 patients whose lives have been extended."
The bundled payment system's affect on dialysis patient deaths
Mor noted that the three-year project intersected with the change to a bundled payment system for dialysis care. "We could not see any change in the outcomes that might be attributable to the change in the payment system," Mor told NN&I.
Mor and the data analysts used the Centers for Medicare and Medicaid Services' Renal Management Information System (REMIS) to track patient deaths during the initiative. Mor showed data indicating that time on dialysis saw a steady increase over the first three years for new patients on dialysis, while data on optimal vascular access placement––either a arteriovenous fistula or a synthetic graft––presented a more erratic picture, with improvements during some months followed by downturns in others. Mor said that data reflects the nationwide performance of access management, as clinics in some parts of the country show better results in avoiding hemodialysis catheters than others.
Tracking the impact of other elements targeted by KCP were more difficult, said Mor. "Nutrition is a complicated one…doctors aren't always good at understanding its role. Tracking the impact of psychosocial and social support was also difficult for us to do."
Kidney Care Partners campaign to protect ESRD funding
The PEAK data was presented during a Congressional educational briefing sponsored by the Congressional Kidney Caucus, made up of legislators who have supported policy helpful to the End-Stage Renal Disease Program. Kidney Care Partners members, along with supporters like former NBA basketball star and kidney recipient Alonzo Mourning, urging Congress not to make any further cuts to the ESRD program, either through federal cuts from the sequestration process or to help pay for other programs.
"As members of Congress look for solutions to the current fiscal crisis, we hope they will understand that cutting this program when we are making measurable progress in improving the delivery of high quality care would negatively impact one of our country’s most vulnerable groups – those with kidney failure who rely on life-saving dialysis for survival," said Ron Kuerbitz, KCP chairman. "We applaud lawmakers' efforts to avert our nation’s financial woes and we recognize everyone needs to be part of the solution. But we hope that Congress remembers the efficiencies we have achieved with our new payment system, and we urge lawmakers to avoid cuts to essential kidney care services."