Through the Reducing Disparities in Access to KidNey Transplantation (RaDIANT) study, Emory University would like your thoughts on barriers to kidney transplantation. Expanding on their previous research in Georgia and ESRD Network 6 (GA, NC, SC), this survey seeks to understand challenges that kidney disease patients face, and will be administered to all of IPRO ESRD Network Program dialysis providers. Voluntary participants of this survey will be asked questions regarding their experience with ESRD patients and to give insight into reasons why some patients are more likely than others to complete the steps to transplant, such as starting the evaluation for a kidney transplant.

Survey Participants: Emory is interested in having 1 provider from each dialysis facility complete this survey, who are most involved with transplant education or patient navigation through the transplant process at their facility. Staff members involved may include:

Results of this study will help interdisciplinary stakeholders in the kidney disease community tailor interventions to improve transplant access among ESRD patients in the future. Although your participation is optional, we encourage you to complete this survey, as the data will be shared with the ESRD Network to incorporate results as part of Quality Improvement Activities with the aim of improving patient kidney transplant outcomes. The survey will be released to transplant leads on August 10, 2021 by the email radiant@emory.edu, and a SurveyMonkey link will be provided at that time.

The proposed rule was released by CMS on July 9, 2021 for review and comments by the community by August 31, 2021. The summary of key issues includes:

You may submit electronic comments on this regulation to http://www.regulations.gov, or by express mail, overnight mail or regular mail to the following address ONLY:

Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-1749-P

P.O. Box 8010

Baltimore, MD 21244-8010

More information can be found at https://www.federalregister.gov/documents/2021/07/23/2021-14973/medicare-program-cy-2022-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part.

Please reach out to your Network if you have any questions.

There is a new emergency temporary standard (ETS) enacted by OSHA that has specific requirements of healthcare entities in relation to what healthcare entities need to provide for their workers. This was officially posted in the Federal Register on 6/21/21.

Occupational Exposure to COVID-19; Emergency Temporary Standard: https://www.federalregister.gov/documents/2021/06/21/2021-12428/occupational-exposure-to-covid-19-emergency-temporary-standard

All healthcare facilities with >10 employees will need a COVID plan that contains the elements in the ETS. There is a template of a plan on the Cal OSHA website. If you have a plan, review the components there. If you don't have a plan, it is a great starting point! www.dir.ca.gov/dosh/dosh_publications/CPP.doc

Patient and Family Engagement (PFE) is an integral part of a successful healthcare team. Acknowledging the positive impact of empowering patients, the IPRO ESRD Network Program aims to increase the numbers of patients and family members representing dialysis facilities through the recruitment of Patient Facility Representative (PFR), previously known as the Network’s Patient Advisory Committee (PAC) members.

Throughout 2021, the IPRO ESRD Network Program will be supporting dialysis facilities and PFR members by providing them with training, resources, interventions, and educational tools to utilize at the facility level. PFE in healthcare is essential to achieve successful outcomes at the facility. PFR members should be incorporated into the Quality Assurance Performance Improvement (QAPI) to provide the patient perspective. This would allow the Network and facility staff to evaluate how PFE has impacted quality measures and patient satisfaction.

ACTION: Facilities are asked to identify and nominate a PFR member (more than one can participate) to help facilitate quality improvement activities. All patients interested in becoming PFR members must have a Patient Facility Representative (PFR) Application and Confidentiality Agreement completed by facility staff.

If your facility already has an existing PAC member that wishes to continue to serve as the PFR, please contact Danielle Andrews, MPH, MSW, GCPH, Community Outreach Coordinator, at 516-209-5549 or danielle.andrews@ipro.us to confirm their ongoing participation with the Network.

According to the World Health Organization (WHO), social determinants of health (SDOH) are the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics (WHO, 2021).

Health inequities have been frequently associated with income level, educational attainment, race/ethnicity, health literacy, access to health services, and safe housing (Rural Health Information Hub, 2021). Individuals within rural areas have a higher likelihood of experiencing these health inequities largely due to limited resource availability. One major contributing factor to health inequities within rural communities is poverty. The average income of a family living within a rural area was about $52,100 in comparison to $68,703 for individuals within a metropolitan area. Living below the poverty line makes it difficult for families to efficiently pay for health care services and health insurance. Poverty has also been associated with increased stress and long-term chronic health issues as well as increased levels of discrimination associated with classism. Generally, poverty has been perceived to have an inverse relationship with positive health outcomes within all living spaces however, rural areas have detrimental effects as their median income is significantly lower than their urban counterparts.

ACTION: Patients that are having difficulties adhering to dialysis treatment may have barriers directly related to rural poverty. Assess these patients and create a safe space while seeking to understand how some SDOHs (especially social-economic status, poverty, access to resources, etc.) have impeded their treatment adherence. Please utilize the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs Screening Tool to help conduct assessments.

Many dialysis patients receiving treatment often do not realize the immense value of including their caregiver and/or family in their plan of care. Through the COVID-19 pandemic many in-person visits transitioned to virtual, making patient and family engagement more critical in improving health outcomes and decreasing hospitalizations.

ChenMed, a value-based care provider, assists with coordination of care for seniors on Medicare who have been diagnosed with multiple chronic conditions. Originating in Florida, their goal is to offer human-centered care in the underserved communities. Primary care physician Dr. Ayesha Ahmed talks about why involving family members can improve outcomes.

Some of the reasons to include family members in a patient’s plan of care include can help the healthcare provider receive an overall picture of the patient’s heath. Additional benefits include improvement on the patient’s mental health and motivation. Involving family can uplift a patient’s attitude towards their health. Lastly, family engagement can help ease difficult decisions including discussions surrounding end of life measures. This approach has proven to keep patients healthier and out of the hospital.

The Clinical Journal of the American Society of Nephrology (CJASN) published a study, “Maybe They Don't Even Know That I Exist: Challenges Faced by Family Members and Friends of Patients with Advanced Kidney Disease", about the challenges experienced by family members of patients with advanced kidney disease.

The IPRO ESRD Network Program encourages dialysis leadership to discuss with staff opportunities to foster patient and family engagement at the facility level. Additional information and resources can be found at https://esrd.ipro.org/patients-family/pfe/.

Peer-to-peer mentoring programs have the potential to assist patients with kidney failure in managing their chronic illness and improve outcomes. Peer programs can influence life planning, goal setting, healthcare decision-making and increase kidney-disease self-management.

ACTION: The following is a list of educational tools and resources to help dialysis facility staff with developing a systematic process to ensure the initial training, continued training, and pairing of ESRD patient peer mentors with patients new to dialysis (mentees). Please share broadly.

Each month the Social Security Administration's Ticket to Work program hosts the Work Incentives Seminar Event (WISE), which are free webinars on vocational rehabilitation services for eligible populations. They are held on the fourth Wednesday of each month. Past WISE webinars can be accessed at WISE on Demand. The next webinar will be held:

When: Wednesday, August 25, 2021

Time: 3:00pm – 4:30pm (EST)

Registration: https://choosework.ssa.gov/wise

Please also visit the IPRO ESRD Network Program website for additional information and resources about vocational rehabilitation.

According to the articles, Home Hemodialysis: a Comprehensive Review of Patient-Centered and Economic Considerations and Evaluating the Benefits of Home- Based Peritoneal Dialysis, the choice of dialyzing at home has been shown to enhance a patient’s quality of life and improve patient outcomes. Patients with kidney disease need education and support to determine the appropriate dialysis modality to fit their lifestyle. Studies have shown with early comprehensive modality education up to 50% of patients starting dialysis will choose a home modality within the first 90 days of treatment. The lifestyle benefits of choosing home hemodialysis or peritoneal dialysis are as follows:

The National Forum of ESRD Networks collaborated with experts in the field and high performing providers in kidney transplant to create a Kidney Transplant Toolkit. In this 6-chapter document, they share tips on how to refer patients to transplant, considerations regarding deceased and living donation options, and how to educate patients about transplant as a treatment option. In addition, they included chapters about the key role dialysis staff have beyond educating about kidney transplant, as well as a transplant financial toolkit for dialysis providers.

Their work also included a collaboration with transplanted patients in creating a patient transplant toolkit: Is a kidney transplant right for me?, which focuses on sharing the patient’s perspective and experience through the transplant journey. This toolkit comes accompanied by this short video with patient’s stories that are easy to relate to.

We would love to hear from you too! Do you have a best practice at your facility that we can share? Please share in this form: https://redcap.ipro.org/surveys/?s=3FWRLTAL89

The U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) are sponsoring a vaccination campaign oriented toward various vaccine-hesitant groups, called We Can Do This. They’ve developed an array of toolkits and resources for many communities.

The campaign also includes half-hour webinar recordings introducing specific categories of resources for: Healthcare workers, Spanish Language, Minority Communities, Older adults and MORE.

Find these toolkits, posters, podcasts, videos, etc., including a selective retrieval tool, at https://wecandothis.hhs.gov/.

Improving the transfer of care from one provider to another is a transition in care. Transitions are often difficult to manage and track at the dialysis facility, but are also difficult for patients due to lack of understanding of discharge orders, medications, follow up, and signs to alert them to worsening.

The use of a transitions champion - much like the vascular access or anemia manager - has been shown to improve patient satisfaction and outcomes (decreased readmissions and emergency room visits resulting in hospitalization). A transitions champion should be selected from the in-center hemodialysis personnel to perform the following:

Need more information related to a transitions champion? Contact Deborah DeWalt, MSN, RN, Quality Improvement Director, hospitalization reduction project lead.

In keeping with the focus of improving health outcomes and access to care in vulnerable populations, ESRD Networks have been tasked by the Center for Medicare & Medicaid Services (CMS) to decrease the rate of infections in peritoneal and central venous catheters used for dialysis as well as to decrease the number of blood transfusions given to ESRD Nursing Home residents dialyzing in a nursing home. The U.S Centers for Disease Control (CDC) estimates 1.3 million Americans live in nursing homes and that 1 to 3 million of them experience serious infections making nursing home residents the most vulnerable of the ESRD population.

To support the reduction of ESRD related infections in the nursing home population, the IPRO ESRD Network Program has selected to share the recent Patient & Family Centered Care (PFCC) Partners presentation. The focus on improving quality, safety and experience of healthcare through the development of partnerships between patients, families and care partners is a best practice. This webinar describes how a California based hospital identified vulnerable nursing home patients at a higher risk of developing infections, and a resulting readmission to the hospital. To address this growing concern, the organization piloted a program to develop coordinated infection prevention activities between care partners that included specialized training and support for nursing home staff.

ACTION: Please review the presentation recording and/or the PowerPoint slides to understand how care partners, who develop a coordinated approach to addressing infections, result in an improved health outcome for our patients. While independent efforts are a start, collaboration and teamwork are significantly more successful than independent efforts.

The IPRO ESRD Data Department provides technical assistance using a customer support system. This is one place for your data submission needs for various systems such as the ESRD Quality Reporting System (EQRS), National Healthcare Safety Network (NHSN), Dialysis data or Quality Incentive program. In order to meet the needs of our facilities, the system will provide support:

NOTE: When submitting a request to the Network, you should NEVER include any patient-specific information such as Name, Date of Birth, Social Security Number, Medicare Claim Number, etc. The only patient identifier that can safely be communicated is the Unique Patient Identifier (UPI) from EQRS.

For more information, please visit the Network website.