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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Improving the understanding, detection, and management of kidney disease.

Quality Improvement/Evidence of Therapy

This section describes current quality improvement and evidence of therapy programs of the Federal government related to chronic kidney disease.

Agency for Healthcare Research and Quality (AHRQ)

AHRQ offers many databases that may be of interest to the kidney community including: the National Healthcare Quality Report, National Healthcare Disparities Report, Medical Expenditure Panel Survey, and Healthcare Cost and Utilization Project.

AHRQ has also established Evidence-Based Practice Centers (EPCs) that produce evidence-based reports and technology assessments on a variety of clinical, behavioral, and organization and financing topics. These evidence reports may be used to inform guidelines, research agendas and quality measures, and serve as the basis for educational materials for patients, providers and policymakers. Additionally, AHRQ leads the Accelerating Change and Transformation in Organizations and Networks (ACTION) program (www.ahrq.gov/research/ACTION.htm). This is a model of field-based research designed to promote innovation in healthcare delivery by accelerating the diffusion of research into practice. One of the current ACTION projects aims to improve adherence to infection control practices in end-stage renal disease facilities to reduce preventable vascular-access infections.

The DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Network is a collection of research centers that conduct studies on the outcomes, effectiveness, safety, and usefulness of medical treatments and services. Recent activity includes the recent report "Comparative Effectiveness of Oral Antidiabetic Medication on Chronic Kidney Disease" and formation of the End-Stage Renal Disease Consortium.

AHRQ has awarded grants that focus on chronic kidney disease and dialysis, in areas such as patient safety, disease management and assessment in complex patients.

Contact Information
Cynthia Palmer, MSc
ACTION Program Officer
Phone: 301-427-1441
Email: cynthia.palmer@ahrq.hhs.gov
Web: www.ahrq.gov



Christine Chang, MD, MPH
Evidence-based Practice Center Program
Phone: 301-427-1512
Email: Christine.chang@ahrq.hhs.gov

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Centers for Disease Control and Prevention (CDC)

CDC's CKD Health Evaluation Risk Information Sharing (CHERISH) is designed to test the feasibility of implementing a chronic kidney disease (CKD) detection/screening program in four states, to assess the degree of kidney disease in a high-risk population, to determine participant's subsequent access to care, and to address the likelihood of disease progression in those with evidence of CKD. This study is being conducted in collaboration with the National Kidney Foundation.

Contact Information
Desmond Williams, MD, PhD
CKD Initiative Team Lead, CDC Division of Diabetes Translation
Phone: 770–488–1158
Email: DEWilliams@cdc.gov
Web: www.cdc.gov/diabetes/projects/kidney.htm

CDC is promoting methicillin-resistant Staphylococcus aureus (MRSA) and S. aureus bloodstream infections (BSI) surveillance and prevention among hemodialysis facilities. This project will be conducted as part of a larger prevention collaborative involving a group of hospitals that are currently using a Positive Deviance Model as a behavior-based social change approach to eliminating healthcare-associated MRSA. In addition to examining the impact within the acute healthcare facilities where Positive Deviance is being applied, CDC will assess the impact on MRSA infection in outpatient dialysis centers that share patients with participating acute healthcare facilities.

Contact Information
Priti Patel, MD, MPH
CDC Division of Healthcare Quality Promotion
Phone: 404–639–4273
Email: PPatel@cdc.gov
Web: www.cdc.gov/diabetes/projects/kidney.htm

CDC, in collaboration with the Veterans Affairs - Puget Sound Health Care System, will examine the natural history of chronic kidney disease (CKD) and evaluate the rate of progression through the stages of CKD and development of complications.

Contact Information
Meda Pavkov, MD, PhD
Phone: 770–488–1160
Email: MPavkov@cdc.gov
Web: www.cdc.gov/diabetes/projects/kidney.htm

CDC's Cost-Effectiveness Study is using a lifetime simulation model to assess the costs and benefits of various interventions. The purpose of this project is to investigate the cost-effectiveness of interventions to prevent, delay, and treat CKD and its complications, and to develop a model that will not only help predict the progression of CKD, but will also test the effectiveness of various public health interventions.

CDC is researching the cost of illness through its Cost of Illness Study to document the direct and indirect costs of CKD and other diseases/conditions.

Contact Information
Desmond Williams, MD, PhD
CKD Initiative Team Lead, CDC Division of Diabetes Translation
Phone: 770–488–1158
Email: DEWilliams@cdc.gov
Web: www.cdc.gov/diabetes/projects/kidney.htm

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Centers for Medicare & Medicaid Services (CMS)

The Dialysis Facility Compare (DFC) contains information about Medicare certified dialysis facilities. Included is facility and contact information, location, types of services, and certification date; as well as quality outcome data for anemia, adequacy of hemodialysis, and survival rates for each facility. DFC allows patients and their family members, as well as professionals, to compare the quality of dialysis facilities across the country, and to access a variety of kidney and dialysis resources. Users are also able to find facility services and quality measures.

The facility information and data comes from two CMS Administrative Data sources: Standard Information Management Systems (SIMS) and Renal Management Information System (REMIS). The quality measure data for anemia and adequacy of hemodialysis comes from end-stage renal disease (ESRD) claims data and the survival data calculated using SIMS and REMIS. The ESRD Networks verify, update, and send data in SIMS to Medicare monthly. REMIS is a database maintained by Medicare with data about dialysis facilities. It includes demographic, medical claims, payment, and entitlement data on people with Medicare who have ESRD; certification and other information for Medicare-certified ESRD providers; and aggregate ESRD patient information.

Contact Information
Name: Thomas Dudley
Phone: 410-786-1442
Email: Thomas.dudley@cms.hhs.gov
Web: http://www.medicare.gov/DialysisFacilityCompare/search.html

The Prevention Quality Improvement Organization Support Center (QIOSC) as contracted by the Centers for Medicare & Medicaid Services (CMS) provided technical assistance and support to select Quality Improvement Organizations (QIOs) that were partnering with community representatives, primary care physicians, nephrologists and vascular surgeons to improve care for patients with chronic kidney disease (CKD). QIOs working on this project represented beneficiaries in Florida, Georgia, Missouri, Montana, Nevada, New York, Rhode Island, Tennessee, Texas, and Utah as well as the United States Virgin Islands.

The CKD Quality Improvement Project promoted early detection of CKD and proper medication treatment to slow the progression of the disease. It also addressed the need for patients who are approaching kidney failure to receive timely counseling to enable safer, higher-quality access to dialysis through a fistula.

The Prevention QIOSC facilitated this important work of the CKD QIOs by:

  • Engaging expert stakeholders and partners
  • Developing and/or disseminating tools
  • Providing educational information and resources
  • Identifying QIO barriers, lessons learned, and success stories
  • Synthesizing and disseminating “what works” information
  • Making the “business case”

Additionally, the Prevention QIOSC supported the goals of the End Stage Renal Disease Networks through partnering with the Fistula First Breakthrough Initiative (FFBI) contractor, Mid-Atlantic Renal Coalition.

The Prevention QIOSC contract was held by Virginia Health Quality Center.

Contact Information
Yvette Williams
Phone: 410-786-6844
Email: Yvette.williams@cms.hhs.gov

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Department of Defense (DoD)

The DoD and Veteran's Administration (VA) work collaboratively to develop evidence-based clinical practice guidelines. The VA/DoD Clinical Practice Guideline (CPG) for the Management of Chronic Kidney Disease was updated and published in 2008. The VA/DoD guideline development process follows a rigorous evidence review and grading process. Guideline champions—subject matter experts, specialists, consultants, and/or individuals doing research in the field—are selected in both VA and DoD. Guideline working group members are selected across the VA and DoD and are part of interdisciplinary teams caring for patients with chronic kidney disease. The guideline working group members develop researchable questions based on the PICO format (problem, intervention, comparison, and outcome) and review the evidence presented in some of the national and international guidelines. There is a contract with an Evidence-Based organization to do a systematic review of the literature and present evidence synthesis to the working group members to minimize bias. Guideline recommendations are developed based on the evidence and graded by the working group members using the same grading process spelled out by the US Preventive Services Task Force. Recommendations for care of patients with chronic kidney disease are outlined in the VA/DoD Clinical Practice Guideline (CPG) for the Management of Chronic Kidney Disease.

After the guideline is approved and published by the VA/DoD Evidence-Based Working Group, consisting of members from the VA, Army, Air Force and Navy, the VA and DoD collaborate to develop implementation tools, clinical documentation, and quality improvement procedures into the electronic medical information systems. VA and DoD are in the process of developing several CKD encounter form templates as well as referral forms for nephrology consultation, renal nutrition, and vascular access placement to better treat patients.

Contact Information
James Ellzy, CDR, US Navy
Director of Clinical Quality
Phone: 703-681-0064
Email: James.ellzy@amedd.army.mil
Web: www.tricare.mil

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Health Resources and Services Administration (HRSA)

Funded by HRSA, the Organ Procurement and Transplantation Network (OPTN) is the unified transplant network established by Congress under the National Organ Transplant Act (NOTA) of 1984. The OPTN is a unique public-private partnership that links Organ Procurement Organizations (OPOs), transplant programs, and histocompatability laboratories together into a national transplant system. The primary goals of the OPTN are to maximize the benefits to patients through patient-centric organ allocation policies; increase the efficiency, effectiveness and safety of the national organ allocation and distribution system; increase the supply of donated organs available for transplantation.

The OPTN monitors the outcomes of OPO's and transplant program's by using risk-adjusted data models and assists members in improving performance outcomes through a peer-mentoring process.

NOTA established the Scientific Registry of Transplant Recipients (SRTR), which provides analytic support to the OPTN in the development and evaluation of OPTN organ allocation and other policies. The SRTR conducts independent research to add to the body of knowledge about organ donation and transplantation. Transplant program and OPO performance data are available on the SRTR website. The SRTR also makes solid organ transplantation data available to bonafide transplant researchers from the time of listing of the potential transplant recipient through graft failure or patient death.

Contact Information
Richard Durbin
Acting Director, Division of Transplantation
Phone: 301–443–680
Email: RDurbin@hrsa.gov
Web: www.organdonor.gov

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Indian Health Service (IHS)

The IHS Kidney Disease Program is working to broaden the Diabetes Standards of Care to include identification and treatment of complications of chronic kidney disease (CKD) (e.g. anemia, bone disease), patient education, and preparation for renal replacement therapy.

The program is also building implementation tools, clinical documentation, and quality improvement procedures into the medical information system. For example, the program offers "Quick Guide Cards" for health professionals on various diabetes related topics, including CKD. Each set includes an overview, resources (e.g. algorithms), and several 'How To' short video tutorials.

The program is also incorporating new data to validate the Modification of Diet in Renal Disease study equation in American Indians and Alaskan Natives. Additionally, IHS developed several CKD encounter form templates as well as referral forms for nephrology consultation, renal nutrition, and vascular access placement to better treat patients.

Contact Information
Andrew S. Narva, MD, FACP, FASN
Chief Clinical Consultant for Nephrology
Phone: 301-594-8864
Email: narvaa@niddk.nih.gov
Web: www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=home

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Veterans Affairs (VA)

The VA and Department of Defense (DoD) work collaboratively to develop evidence-based clinical practice guidelines. The VA/DoD Clinical Practice Guideline (CPG) for the Management of Chronic Kidney Disease was updated and published in 2008. The VA/DoD guideline development process follows a rigorous evidence review and grading process. Guideline champions are selected in both VA and DoD who are subject matter experts, specialists and consultants or who are doing research in the field. Guideline working group members are selected across the VA and DoD and are part of interdisciplinary teams caring for patients with chronic kidney disease. The guideline working group members develop researchable questions based on the PICO format (problem, intervention, comparison, and outcome) and review the evidence presented in some of the national and international guidelines. There is a contract with an Evidence-Based organization to do a systematic review of the literature and present evidence synthesis to the working group members to minimize bias. Guideline recommendations are developed based on the evidence and graded by the working group members using the same grading process spelled out by the US Preventive Services Task Force. Recommendations for care of patients with chronic kidney disease are outlined in the VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease.

After the guideline is approved and published by the VA/DoD Evidence-Based Working Group, consisting of members from the VA, Army, Air Force and Navy, the VA and DoD collaborate to develop implementation tools, clinical documentation, and quality improvement procedures into the electronic medical information systems. VA and DoD are in the process of developing several CKD encounter form templates as well as referral forms for nephrology consultation, renal nutrition, and vascular access placement to better treat patients.

VA also collaborates with the Center for Medicare and Medicaid Services (CMS) in their quality improvement programs pertaining to dialysis care. All VA dialysis units participate in CMS' Fistula First Breakthrough Initiative (FFBI) and Clinical Performance Measure (CPM) assessments through regular reporting via CROWNWeb.

Contact Information
Susan Crowley, MD
VHA National Program Director for Kidney Disease & Dialysis
Phone: 203-932-5711 ext 3950
Email: Susan.Crowley@va.gov
Web: www.patientcare.va.gov

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This information was reviewed by KICC agency representatives. It may not reflect new or future agency activities. For more information, please contact the listed representatives.

Page last updated: June 6, 2012