1. 2015 Network Notables October 27, 2015 Danielle R. Daley, MBA Executive Director

2. ESRD Network of New England Mission Statement The Mission of the End Stage Renal Disease Network of New England is to promote health care for all ESRD patients that is safe, effective, efficient, patient- centered, timely, and equitable.

3. 3 Agenda  IPRO ESRD Network of New England Administration  Patient Services and Community Outreach Activities  Quality Improvement Activities  ESRD Data Management Systems 3

4. IPRO ESRD Network of New England Administration Danielle R. Daley, MBA Executive Director Jenna Vonaa Senior Program Support Coordinator

5. IPRO ESRD Network Service Area 5 Network 1 CT, MA, ME NH, RI, VT 13,580 ESRD Patients 186 Dialysis Providers 15 Transplant Centers

6. 66 NW1 Demographics by State State ESRD Patient Census # of Dialysis Facilities # of Transplant Facilities Connecticut 3,978462 Maine 1,008181 Massachusetts 6,239809 New Hampshire 932181 Rhode Island 1,103161 Vermont 32081 TOTAL13,58018615

7. 77 Network Facility Affiliation by State Ownership ESRD Patient Census # of Dialysis Facilities American Renal Associates 1,63122 DaVita 4,17344 Fresenius Medical Care 5,26771 Diversified Services Inc. 1753 Dialysis Clinic Inc. 6979 Independent 1,53033 Veteran Affairs 1074 TOTAL13,580186

8. Kristin Brickel, RN, MSN, MHA, CNN Quality Improvement Director Heather Camilleri, CCHT Quality Improvement Coordinator Brittney Jackson, LMSW Patient Services Director Kayla Abella Community Outreach Coordinator Jaya Bhargava, PhD, CPHQ Operations Director Krystle Gonzalez Sr. Data Coordinator Jenna Vonaa Sr. Program Support Coordinator Danielle Daley, MBA Executive Director ESRD Network Staff Quality Improvement Patient Services Data

9. 9 ESRD Network Role  Improve quality of care for ESRD patients  Collect data to measure quality of care  Provide assistance to ESRD patients and providers  Evaluate and resolve patient grievances 9

10. 10 2015 Campaigns and QIAs 2013-2015 SOW IPRO ESRD Network of New England ProjectsClinics Involved Section Project Titles# Campaigns PFE LANPatient Advisory Committee Recruitment25 PFE LANEmergency Preparedness Awareness41 QIAs PFE LANFluid Management Awareness20 GrievanceCommunications5 FFCLVascular Access AVF: 170 LTC: 90 HAIHealthcare Associated Infections42 Aim 2Referral to Home Therapies9

11. Patient Services and Community Outreach Activities Brittney Jackson, LMSW Patient Services Director Kayla Abella Community Outreach Coordinator

12. 2015 Patient Services Projects  2 Educational Campaigns  Emergency Preparedness Awareness  Patient Advisory Committee Recruitment  2 Quality Improvement Activities  Fluid Management Awareness  Enhancing Patient-Provider Communication 12

13. Patient and Family Engagement Campaign Goals and Outcomes  Goals  Impact 20% of Network population  Achieve 10% relative improvement  Baseline  10.9% Facilities represented by a PAC member  53.2% Emergency preparedness awareness  Outcomes  26.6% Facilities represented by a PAC member (↑ by 15.7%)  71.1% Emergency preparedness awareness (↑ by 17.9%) 3

14. Patient and Family Engagement QIA Goals and Outcome  Goals  Impact 10% of Network population  Achieve 5% relative improvement  Baseline  62.6% Fluid management awareness  Outcome  78.3% Fluid management awareness (↑ by 15.7%) 4

15. Grievance QIA  Positive Enhancement Communication Sessions (PECS)  5-7 minute patient-provider interviews  Promote behavioral change ● Collect 50 pledges from patients and provider staff committed to fostering and maintaining positive communication in the facility  Outcomes  110 PECS completed ● 21.6% of grievance population  64 pledges received ● Exceeded secondary behavioral goal by 28%  No topic area grievances received in target facilities during project period 6

16. Quality Improvement Activities Kristin Brickel, RN, MSN, MHA, CNN Quality Improvement Director Heather Camilleri, CCHT Quality Improvement Coordinator

17. 2015 Quality Improvement Projects  Innovation Project  Home Therapy Referrals  QIP Education & Assistance  Quality Improvement Activities  Vascular Access Improvement  Healthcare Associated Infection Surveillance 17

18.  Baseline: September 2014  Goals  Increase AVF by 1%  Decrease LTC > 90 days by 2%  Re-measure: September 2015  Data available December 2015 *Facilities that have >10% LTC at baseline 18 Network 1 BaselineGoal AVF Rate66.17%67.17% LTC Rate14.97%*12.97% Vascular Access Progress

19. < 50% >50% - <58% >58% - 68% >10% - 15% >15% Vascular Access Monitoring  Tier facilities for target interventions  Set facility-level goals  Conduct site visits  Promote ESRD NCC resources  Provide monthly access reports  Data validation  Share best practices >68% AVF LTC 8

20. AIM 2 Innovation Project Home Therapy Referrals  Impact 5% of Network population  Identify disparity  Facility selection  Project goals  5% increase in referrals of eligible patients  1% reduction in identified disparity gap Disparate Population Referrals Non- Disparate Population Referrals Total Referrals 3

21. AIM 2 Interventions  Resource Toolkit  Site Visits  Options education  Technical assistance  Identify barriers  Share best practices  AREP Symposium  Peer Mentoring Program  Referral tracking / monitoring 5

22. AIM 2 Measureable Improvement  Baseline data  11.0% disparate population referrals  20.9% non-disparate population referrals  16.4% total referrals  9.9% disparate gap  Outcome measures (July 2015 data)  69.9% disparate population referrals (↑ by 58.9%)  69.3% non-disparate population referrals (↑ by 48.4%)  69.6% total referrals (↑ by 53.2%)  -0.6% disparate gap (↓ by 10.5%)  Final re-measure - September 2015 performance Disparate Gap Total Referrals 1% 5% Project Goals 7

23. ESRD Data Management Jaya Bhargava, PhD, CPHQ Operations Director Krystle Gonzalez Senior Data Support Coordinator

24. Data Reporting  Streamlined notifications to facilities missing data  Achieved >95% reporting compliance Network-wide  CROWNWeb  NHSN  Use of GoToMeeting for real-time, one-on-one technical assistance 7 ESRD QIP NHSN CROWNWeb

25. THANK YOU FOR ALL YOUR EFFORTS IN 2015!!

26. 2015 Quality Awards October 27, 2015 Danielle R. Daley, MBA Executive Director

27. The IPRO End Stage Renal Disease (ESRD) Network Quality Awards Program is designed to recognize members of the New England ESRD community who have consistently raised quality standards by delivering exceptional care to dialysis and transplant patients. The award categories align with the mission of the Network to promote healthcare for all ESRD patients that is safe, effective, efficient, patient-centered, timely, and equitable. 27

28. AV Fistula Champions

29. >68% AVF Rates: June 2014- June 2015 Connecticut DaVita Branford Dialysis DaVita Danbury Dialysis DaVita Greater Waterbury DaVita New London Dialysis DaVita Stamford Dialysis DaVita Torrington DaVita Waterbury Heights FMC Forestville FMC Hartford PDI Rocky Hill Maine DaVita Lincoln Lakes Dialysis FMC Casco Bay Dialysis FMC Damariscotta Dialysis FMC Southern Maine Dialysis 29

30. >68% AVF Rates: June 2014- June 2015 Massachusetts DaVita Burlington Regional Dialysis DaVita North Andover Renal Center DaVita Salem Northeast Dialysis DaVita Wellington Circle Dialysis DCI Boston DCI Brigham/Faulkner DCI Walden Pond FMC Cape Cod Artificial Kidney FMC Framingham FMC Mashpee FMC Newburyport FMC North Shore Regional Dialysis Center VA Medical Center - Boston New Hampshire DaVita Nashua Dialysis DaVita Steam Dialysis FMC Londonderry FMC Manchester Kidney Center FMC New Hampshire Kidney Center FMC Rockingham County FMC Seacoast Dialysis Center 30

31. >68% AVF Rates: June 2014- June 2015 Rhode Island ARA Dialysis Center of East Providence ARA Dialysis Center of Providence ARA Dialysis Center of Tiverton ARA Wakefield Dialysis Center Dialysis Center of Rhode Island Hospital NNA Pawtucket VA Medical Center - Providence Vermont University of Vermont Medical Center Dialysis - Rutland 31

32. >68% AVF Rates: June 2014- June 2015 32 Highest Arteriovenous Fistula Rate DaVita New London - Connecticut

33. Data Submission Champions

34. Leaders in Data Submission Connecticut DCI Manchester Dialysis Center DCI UCONN Dialysis Center FMC Enfield Dialysis Center Maine Berkshire Medical Center County Dialysis Center DCI Belfast New Hampshire FMC Cocheco River Vermont Southwestern Vermont Renal Center 34

35. Leaders in Data Submission Rhode Island ARA Dialysis Center of East Providence ARA Dialysis Center of Pawtucket ARA Dialysis Center of Providence ARA Dialysis Center of Westerly ARA Dialysis Center of West Warwick ARA Dialysis Center of Woonsocket ARA Wakefield Dialysis Center Dialysis Center of Rhode Island Hospital Massachusetts ARA Fall River Kidney Center LLC ARA Hawthorn Kidney Center Wareham ARA Heritage Dialysis Center, LLC. ARA Ludlow Dialysis, LLC ARA Springfield Dialysis Center ARA Wellesley Dialysis DCI Boston DCI Walden Pond FMC Hampshire County Dialysis Center FMC North Shore Regional Dialysis FMC Peabody Dialysis Center 35

36. 36 Highest Data Submission ARA Wakefield Dialysis Center - Rhode Island Leaders in Data Submission

37. . 37 IPRO ESRD Network of New England applauds the exemplary contributions of the following champions in the ESRD community: Patient Advisory Committee Award Hampshire County Dialysis Center - Massachusetts Communication Award DCI Ball Square - Massachusetts Emergency Preparedness Award Manchester Kidney Center - New Hampshire

38. 38 IPRO ESRD Network of New England applauds the exemplary contributions of the following champions in the ESRD community: Continuous Quality Improvement Helen Brickel, RN - DaVita New Haven, Connecticut Patient Engagement Todd Sisson, MSW, LICSW - FMC Providence, Rhode Island Excellence in ESRD Care Christine Waller, LICSW - Heritage Dialysis, Massachusetts

39. Charles Paige Patient Advocate Award

40. Charles H. Paige, Sr. 40 The Patient Advocate Award was named in memory of the life of Charles H. Paige, Sr., a founding member of the Network Patient Advisory Committee (PAC), and valued community member. Charles began dialysis in 1989 and diligently worked to help others understand renal disease, while maintaining an upbeat attitude and willingness to assist others.

41. . 41 The Network is please to announce the 2015 Charles Paige Patient Advocate Award Recipient, Roy E. Graham. Roy is the Network Patient Advisory Committee (PAC) Chair and active member of the Network Council and Medical Review Board. The Network thanks Roy for his continued passion in being a positive role model for ESRD patients and his support in ensuring that Network initiatives are patient-centered. Roy E. Graham