End-Stage Renal Disease (ESRD) Research
Descriptions of Projects
Dialysis Facility Reports (DFRs)
Under the “ESRD Data Reports for CMS, State, and Facility Oversight” and the “End-Stage Renal Disease Measures Support” contracts, UM-KECC publishes annual reports for the 5000+ dialysis facilities in the US. These reports include summaries of patient characteristics, patient outcomes, and practice patterns at every dialysis facility. The DFRs also compare the practices and outcomes of dialysis facilities to other dialysis facilities in their ESRD network, State and the U.S. The reports also include direct measures of the quality of services as well as patient outcomes that may be influenced by these services. The DFRs are sent to the ESRD Networks in July every year for dissemination to the dialysis facilities. UM-KECC then conducts a review period during which dialysis facilities can enter questions and comments about their DFR. UM-KECC responds to all questions and comments from the facilities.
Dialysis Facility Compare Website
Under the “End-Stage Renal Disease Measures Support” contract UM-KECC, in collaboration with Arbor Research Collaborative for Health, prepares three quality measures from the DFRs to appear on the Dialysis Facility Compare (DFC) web site. The DFC website allows patients, families, and others to compare dialysis facilities on a number characteristics and on the quality measures for anemia, Hemodialysis adequacy, and patient survival.
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DFRs and Profiles for CMS Survey and Certification
Under the “End Stage Renal Disease Data Reports for CMS, State, and Facility Oversight”, UM-KECC distributes the DFRs to the State and Region Survey Agencies, who are responsible for surveying dialysis facilities for Medicare certification. UM-KECC also prepares other supporting material to assist these agencies in targeting and prioritizing dialysis facilities for survey. The comments for the survey agencies entered by the facility during the review period are appended to the DFRs , which are sent to the State Surveyors.
DFRS and CROWNWeb
In June 2007, UM-KECC completed a CMS contract to prepare for adding 13 additional clinical performance measures (CPMs) to the DFRs. These measures have been collected since 1994 on a nationally-representative sample of dialysis patients by the ESRD Core Indicators and ESRD Clinical Performance Measures projects. In the future, these CPMs will be collected on all dialysis patients by the CROWNWeb system, now under development at CMS. (see also the “End-Stage Renal Disease Measures Support” contract below).
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End Stage Renal Disease Measures Support (ESRD Measures)
This CMS contract involves providing technical support for the maintenance and collection of current ESRD quality measures, and includes research that develops, maintains, and updates the technical specifications for each measure. Also part of this project is the construction and maintenance of appropriate databases for analysis and report generation. UM-KECC is a subcontractor to Arbor Research Collaborative for Health on this contract. The ESRD quality measures have been collected since 1994 on a nationally-representative sample of dialysis patients by the ESRD Core Indicators and ESRD Clinical Performance Measures projects. The 2006 Annual Report on the CPM data was prepared under this contract. Under the ESRD Measures contract, all of the quality measures have been documented and formally specified, have been reviewed by Technical Expert Panels, and have been submitted to the National Quality Forum for formal approval. In the future, these CPMs will be collected on all dialysis patients by the CROWNWeb system, now under development. The ESRD Measures contract also supports the Dialysis Facility Reports (DFRs—see above) and provides the three quality measures included in the Dialysis Facility Compare (DFC) web site.
ESRD Prospective Payment System: (Development of a Fully Bundled Prospective Payment System for Outpatient End Stage Renal Disease Facilities)
This multi-phase project contracted by CMS charges UM-KECC with developing a Basic Case-Mix Adjusted bundled payment system that appropriately reimburses dialysis providers with a new composite rate payment amount that reflects the actual current costs involved in providing dialysis care to ESRD patients.
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STAR (Surveyor Technical Assistant for Reporting)
The mission of the Survey and Certification ESRD Program is to ensure dialysis centers, transplant centers, and organ procurement organizations’ compliance to Federal regulations, thereby ensuring and improving the health and safety of the ESRD beneficiaries; The Surveyor Technical Assistant for Reporting (STAR) advances this mission by improving the efficiency, accuracy, completeness, and consistency of the survey process. This project, “Utilization of On-Site data indicators in the ESRD Survey Process”, provides support for the implementation and further development of STAR
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Dialysis Outcomes and Practice Patterns Study (DOPPS)
The DOPPS is a prospective cohort study based on the collection of observational longitudinal data for a random sample of patients from a representative and random sample of units in 12 countries (Australia, Belgium, Canada, France, Germany, Japan, Italy, New Zealand, Spain, Sweden, the United Kingdom, and the United States). In view of differences in patient outcomes of mortality and morbidity by country and by dialysis unit, it is hypothesized that differences in practice patterns correlate with outcome differences, and that understanding the factors associated with patient outcomes will lead to improved patient care and lower mortality and morbidity. Practice Patterns refer to the general range of treatment options faced by dialysis units. Examples of practice patterns that may be related to outcomes include: staffing ratios and composition, size of unit, vascular access creation and salvage policies, dialyser reuse and methods of delivering dialysis. Outcomes refers to a variety of patient events that are associated with human and economic consequences. Important outcomes include: mortality, hospital admission, vascular access failure, quality of life, and development of new medical conditions. DOPPS is a project of Arbor Research Collaborative for Health. UM-KECC is a subcontractor for DOPPS.
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