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Population Health Focused Pilot Quality Improvement Activity (PHFPQ):

Support Gainful Employment of ESRD Patients

As directed by the Statement of Work, each ESRD Network is required to develop one Population Health Focused Pilot Project “that incorporates the concepts of boundariliness and unconditional teamwork into innovative approaches that are customer-focused and sustainable to achieve the established measures.” Project selection is data driven and facilities were chosen based on CMS requirement that ≤25% of patients met the desired outcome during project baseline (October 2017-June 2018).

The goals of this project are to: (1) increase referrals made for vocational rehabilitation (VR) services, (2) increase numbers of patients receiving services, and (3) develop a process to ensure that 100% of patients are screened for interest in VR services and that responses are entered in CROWNWeb.  CROWNWeb data supplied by the ESRD NCC showed that vocational rehabilitation services were both under-utilized and under-reported in participating facilities during 2018. Option year two RCA results showed the top three barriers for VR under-utilization were: 1) lack of personal motivation/willingness to participate in VR services, 2) fear of losing Medicare and/or disability benefits, and 3) poor physical health.

Forty-six Network 8 facilities have been selected to participate in the project: 14 from Alabama, 10 from Mississippi, and 22 from Tennessee, which equals 10% of the total number of dialysis facilities in each state. By corporate ownership, 28% are DaVita units, 11% are DCI units, 44% are FMC units and 17% are independently owned units.

Network Project Leads:

Kristi Durham, Quality Improvement Coordinator

Casey Magee, Outreach Coordinator

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