Abstract: FR-PO828

Capturing and Reporting Performance Measures for Chronic Hemodialysis Care: The Veterans Health Administration (VHA) Dialysis Dashboard Experience

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Fischer, Michael J., University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, United States
  • Sovern, Karen, Department of Veterans Affairs, Cincinnati, Ohio, United States
  • Crowley, Susan T., Veterans Health Administration, West Haven, Connecticut, United States
Background

End-stage renal disease (ESRD) is a common, burdensome, and costly chronic condition among Veterans. Assessment and improvement of the quality of Veteran chronic hemodialysis (HD) care is a VHA goal. However, VHA has historically been reliant on external vendors to provide assessments of chronic VHA HD facility-level performance and to meet stakeholder requests for quality reports.

Methods

The VHA National Kidney Program began a process of leveraging multiple kidney disease and dialysis informatics initiatives to build an internal kidney disease surveillance system in 2012. A four step process was used to develop and implement a national VHA Dialysis Dashboard for capturing and reporting of clinical performance measures (PMs) for approximately 3000 Veterans at 71 VHA HD facilities. This electronic dashboard is accessible by VA operations and clinical dialysis staff for quality assurance and improvement activities.

Results

First, the assembly of a diverse stakeholder committee was required to achieve broad consensus for PMs and ensure acceptance in the field. Second, a process for conducting an environmental scan of existing ESRD/HD PMs and vetting was developed. Through teleconference discussions and web-based voting on 78 PMs from recognized reference organizations, 11 mature facility-level PMs were selected that encompass dialysis adequacy, vascular access, anemia, mineral metabolism, and infection. Third, collaboration across different VHA service lines proved essential to create this dashboard, which leveraged the VA electronic medical record and data warehouses, and created a web-based application for field reporting. Fourth, a coordinated series of national rollout calls, pilot testing, and user acceptance testing was essential for final implementation. The Dashboard was fully implemented in 2013, and by 2016 there was 100% VA dialysis facility participation and 96% usable records for PMs.

Conclusion

The VHA Dialysis Dashboard is a versatile surveillance and reporting tool to provide national and facility level assessment of the quality of chronic dialysis care, to guide and motivate high quality care, to target quality improvement efforts at a facility level, and to provide an atmosphere for promoting a cohesive approach to process improvement efforts at a national level.

Funding

  • Veterans Affairs Support