2015 Annual Report - IPRO...The End Stage Renal Disease Network Organization Program (ESRD Network...

Castle Hill Lighthouse, Newport, RI

November 2016Prepared by: IPRO ESRD Network of New Englandesrd.ipro.org

Submitted to:U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Services for Contract Number HHSM-500-2016-00019C

2015 AnnualReport

TABLE OF CONTENTS Page

Report Highlights ........................................................................................................................... 1Introduction .................................................................................................................................... 3

CMS’ End Stage Renal Disease Network Organization Program ..................................................... 3Medicare Coverage for Individuals with ESRD .................................................................................. 3History of CMS’ ESRD Network Organization Program .................................................................... 3IPRO ESRD Network of New England (Network 1) ........................................................................... 3Network Goals .................................................................................................................................... 5

Profile of Patients in the Network’s Service Area ........................................................................ 7Incident Patient Population ............................................................................................................... 7Prevalent Patient Population ............................................................................................................. 7Renal Replacement Therapy .............................................................................................................. 7

Improving Care for ESRD Patients ................................................................................................. 9Engaging Patients in Their Healthcare .............................................................................................. 9Other Network 1 Activities that Improve Care for ESRD Patients ................................................. 14Facilities that Consistently Failed to Cooperate with Network Goals ........................................... 17Recommendations to CMS for Additional Services or Facilities ..................................................... 17

Grievances and Access to Care .................................................................................................... 18Grievance Cases Referred to State Survey Agencies ....................................................................... 19Positive Enhancement Communication Sessions (PECS) ................................................................. 19

Emergency Preparedness and Response ..................................................................................... 20Emergency Events During 2015 ....................................................................................................... 20Emergency Activity Highlight .......................................................................................................... 21

List of Data Tables ........................................................................................................................ 22Data Tables ................................................................................................................................... 23

1

REPORT HIGHLIGHTS

The IPRO End-Stage Renal Disease (ESRD) Network of New England is funded by the federal government to promote the provision of quality healthcare that is safe, effective, efficient, patient-centered, timely, and equitable for all ESRD patients in the six New England states, To achieve this goal, Network staff works with providers, patients, and other stakeholders toward improving care, engaging and empowering patients as consumers, and conducting the activities consistent with the National Quality Strategy’s1 three broad aims and the Centers for Medicare & Medicaid Services’ (CMS) priorities:

• Better care for the individual through beneficiary and family centered care;

• Better health for the ESRD population; and

• Reduce costs of ESRD care by improving care.

Throughout 2015, the Network continued to demonstrate efficacy and leadership in promoting the integration of these priorities in the care of patients living with ESRD. To that end, the Network strived to achieve direct engagement with the community by fostering opportunities to promote patient- and family-centered care at the facility level. Patient Subject Matter Experts (SMEs) actively participated in the design of educational campaigns and Quality Improvement Activities (QIAs). The Network conducted several successful initiatives designed to educate and empower patients to take an active role in their care. Highlights of SME involvement, which contributed to the Network exceeding goals in the following activities, include:

• The Patient Advisory Committee Recruitment campaign increased the number of patient representatives that serve as peer-to-peer mentors in the Network service area. The Network recruited and engaged 70 PAC members from 49 dialysis facilities (26.6% of certified dialysis centers in the Network area) to participate in Network projects and activities. This resulted in a 15.7 percentage point improvement from 20 dialysis facilities (10.9%) at baseline. For detailed information, please see page 9.

• The Fluid Management Awareness QIA educated patients about dietary guidelines and the effects of excessive dietary fluid intake. Prior to the QIA, patients took a baseline test to assess their understanding of dietary fluid management; scores showed a 62.6% average correct response rate. Post intervention tests indicated that patients’ understanding of dietary fluid management increased by 15.7 percentage points, with a 78.3% average correct response rate on re-measurement. For detailed information, please see page 10.

• The Emergency Preparedness Awareness campaign was designed to educate patients about how they should prepare for emergencies. Prior to the campaign, patients took a baseline test to assess their understanding about preparedness strategies and vital resources needed during an emergency; scores

1 Agency for Healthcare Research and Quality. (n.d.) About the National Quality Strategy (NQS). Retrieved from: http://www.ahrq.gov/workingforquality/about.htm

2

showed a 53.2% average correct response rate. Post-campaign tests indicated that patients understanding of emergency planning increased by 17.9 percentage points, with a 71.1% average correct response rate on re-measurement. For detailed information, please see page 11.

• For the Population Health Innovation Pilot Project, the Network focused on increasing the referral rate for home therapies and decreasing the identified racial disparity by educating eligible ESRD patients about viable treatment options. The home dialysis referral rate was increased by 59.3 percentage points from 16.4% at baseline to 75.7% at re-measurement. The disparity gap was eliminated in the identified facilities. For detailed information, please see page 12.

• The Enhancing Patient-Provider Communication QIA helped remove communication barriers between patients and healthcare professionals in five target facilities, with a total of 514 patients. Interviews between patients and facility staff, Positive Enhancement Communication Sessions, conducted with 10.7% of the patient population in the target facilities, resulted in zero grievances in the area of communications/professionalism being filed with the Network. For detailed information, please see page 19.

3

INTRODUCTION

CMS’ End Stage Renal Disease Network Organization Program

The End Stage Renal Disease Network Organization Program (ESRD Network Program) is a national quality improvement program funded by the Centers for Medicare & Medicaid Services (CMS). CMS is a federal agency, part of the U.S. Department of Health and Human Services (HHS).

CMS defines end stage renal disease (ESRD) as permanent kidney failure in an individual who requires dialysis or kidney transplantation to sustain life.

Under contract with CMS, 18 ESRD Network Organizations, or ESRD Networks, carry out a range of activities to improve the quality of care for individuals with ESRD. The 18 ESRD Networks serve the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, American Samoa, Guam, and the Northern Mariana Islands.

Medicare Coverage for Individuals with ESRD

Medicare coverage was extended to most ESRD patients in the U.S. under the Social Security Act Amendments of 1972 (Public Law 92-603). Individuals with irreversible kidney failure are eligible for Medicare if they need regular dialysis or have had a kidney transplant and they meet (or their spouse or parent meets) certain work history requirements under the Social Security program, the railroad retirement system, or federal employment.

History of CMS’ ESRD Network Organization Program

Following passage of the 1972 Amendments to the Social Security Act, in response to the need for effective coordination of ESRD care, hospitals and other health care facilities were organized into networks to enhance the delivery of services to people with ESRD.

In 1978, Public Law 95-292 modified the Social Security Act to allow for the coordination of dialysis and transplant services by linking dialysis facilities, transplant centers, hospitals, patients, physicians, nurses, social workers, and dietitians into Network Coordinating Councils, one for each of 32 administrative areas.

In 1988, CMS consolidated the 32 jurisdictions into 18 geographic areas and awarded contracts to 18 ESRD Network Organizations, now commonly known as ESRD Networks. The ESRD Networks, under the terms of their contracts with CMS, are responsible for: supporting use of the most appropriate treatment modalities to maximize quality of care and quality of life; encouraging treatment providers to support patients’ vocational rehabilitation and employment; collecting, validating, and analyzing patient registry data; identifying providers that do not contribute to the achievement of Network goals; and conducting onsite reviews of ESRD providers as necessary.

IPRO ESRD Network of New England (Network 1)

The role of the IPRO ESRD Network of New England (Network 1) is to improve the quality of care for people who require dialysis, transplantation, and/or related life-sustaining treatment for ESRD, The Network aligns its mission and activities with the National Quality Strategy’s three broad aims and the Centers for Medicare &

4

Medicaid Services (CMS) priorities. Our goals, our methodology for attaining them, and our achievements are described throughout this report.

Network 1 serves dialysis providers and ESRD patients in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. The Network is operated by IPRO, an independent, not-for-profit national organization.

IPRO offers a full spectrum of healthcare assessment and improvement services that foster more efficient use of resources and enhance healthcare quality to achieve better patient outcomes. Founded in 1984, IPRO holds contracts with federal, state, and local government agencies, as well as private sector clients, in more than 33 states and the District of Columbia. IPRO works to improve the quality and value of healthcare services by partnering with providers to improve care/health outcomes, fostering medically necessary and appropriate care, and promoting value-driven healthcare.

As part of IPRO, the Network is provided direct access to technical assistance from a broad range of professionals in quality improvement, infection control, mental health, primary care, health policy, information technology, and communications. Our corporate resources enhance the Network’s effectiveness in engaging and empowering ESRD patients and collaborating with dialysis providers to improve the quality of the care they deliver. IPRO is fully committed to promoting and achieving the goals and vision of the ESRD Network Program, as we work to provide support to the patients and providers within the Network’s service area.

According to Census Bureau data, the combined population of the six New England states is approximately 14.72 million people (2015 estimates based on 2010 census; http://www.census.gov/). The individual New England states differ widely in population and geography. This variation influences the availability of ESRD services and treatment choices. Maine has the largest geographic distribution of the six New England states, yet has the lowest population density of the six states. Rhode Island, the smallest state, has the highest population density of the six states. The majority of the residents in Connecticut, Massachusetts, and Rhode Island live in metropolitan areas.

The Network’s activities support approximately 13,958 patients reported as receiving dialysis treatment for ESRD as of December 2015. These patients were served by 186 Medicare certified dialysis facilities, which includes four Veterans Affairs (VA) hospitals. There are 15 transplant centers in the Network service area.

For a complete analysis of the population of ESRD patients served by dialysis facilities, and transplant centers in New England, refer to the Data Tables starting on page 23.

5

Table A. Dialysis Facilities and Transplant Centers in the Network’s Service Area, as of December 31, 2015

Category Number*

Number of Dialysis Facilities in IPRO ESRD Network of New England’s Service Area* 186 Number of Transplant Centers in IPRO ESRD Network of New England’s Service Area* 15

Source: CROWNWeb *Counts of dialysis facilities and transplant centers may include a small number of facilities that closed during the calendar year but did not have a closing date recorded in CROWNWeb as of December 31, 2015.

Table B. Number of Medicare-Certified Dialysis Facilities in the Network’s Service Area and Number and Percent of Dialysis Facilities Offering Dialysis Shifts Starting after 5 PM, as of December 31, 2015

Category Number* Percent

Number of Dialysis Facilities in IPRO ESRD Network of New England’s Service Area* 186

Dialysis Facilities in IPRO ESRD Network of New England’s Service Area Offering Dialysis Shifts Starting after 5 PM* 61 32.8%

Source: CROWNWeb *Counts of dialysis facilities and transplant centers may include a small number of facilities that closed during the calendar year but did not have a closing date recorded in CROWNWeb as of December 31, 2015.

Network Goals

CMS establishes priorities for the ESRD Network contractors annually in the statement of work (SOW) section of each Network’s contract with the agency. These priorities support CMS' and HHS' national quality improvement goals and priorities.

In 2015, the ESRD Network contractors were tasked with meeting the following goals:

• Improving care for ESRD patients in the Network’s service area by:

• Promoting patient- and family-centered care;

• Responding to grievances about ESRD-related services filed by, or on behalf of, ESRD patients;

• Supporting improvement in patients’ experience of care;

• Working with dialysis facilities to ensure that all dialysis patients have access to appropriate care;

• Promoting best practices in vascular access management; and

• Helping dialysis facilities reduce the incidence of healthcare-associated infections.

6

• Improving the health of the ESRD patient population in the Network’s service area through activities designed to reduce disparities in ESRD care; and

• Reducing the costs of ESRD care in the Network’s service area by supporting performance improvement at the dialysis facility level and supporting facilities’ submission of data to CMS-designated data collection systems.

To achieve these goals, the Network works with its Network Council, Medical Review Board, Patient Advisory Committee, Grievance Committee, and Network activity specific-committees to develop quality improvement projects with goals based on the ESRD Network's SOW. In 2015, the Network deployed interventions that targeted patients, dialysis and transplant providers, and other stakeholders. These interventions focused on engaging patients, reducing disparities, and improving quality of care for ESRD patients. They are detailed throughout this report.

7

PROFILE OF PATIENTS IN THE NETWORK’S SERVICE AREA

The ESRD Network Program collects data on incident (new) ESRD patients, prevalent (currently treated) dialysis patients, and renal transplant recipients.

The Network uses data on patients’ clinical characteristics—including primary cause of ESRD, treatment modality, and vascular access type—to focus its outreach and quality improvement activities.

Incident Patient Population

In the Network’s service area, the number of individuals new to ESRD treatment (incident population) in 2015 increased by 1.1% from 2014 to 3,995 patients. Females comprised 39.7% of the incident cases. The percent of patients age 64 and younger decreased by a 0.76 percentage point to 44.75%.

Diabetes continues to be the primary cause of ESRD in incident patients, followed by hypertension/large vessel disease.

Prevalent Patient Population

Growth in the number of individuals receiving dialysis in New England at year end (prevalent population) increased by 3.2% from 2014 to 13,923 individuals as of December 31, 2015. Males represented 58.7% of prevalent dialysis patients in New England. The percent of patients age 64 and younger increased by 2.9 percentage points to 48.4%.

Renal Replacement Therapy

In 2015, 756 renal transplants were performed at 15 transplant centers throughout New England. This represents a 5.9% decrease in renal transplants compared to the previous calendar year.

For a complete analysis of ESRD patients in New England, treatment types, and location of treatment, refer to the Data Tables starting on page 23.

Table C. Clinical Characteristics of the ESRD Population in the Network’s Service Area, Calendar Year 2015

Category Number Percent

Incident (New) ESRD Patients 3,995

Number of Incident ESRD Patients, Calendar Year 2015 3,995 100

Prevalent Dialysis Patients Number of Prevalent Dialysis Patients as of December 31, 2015 13,923

Treatment Modality of Prevalent Dialysis Patients as of December 31, 2015

In-Center Hemodialysis or Peritoneal Dialysis 12,386 88.8

In-Home Hemodialysis or Peritoneal Dialysis 1,561 11.2

Total 13,947 100

8

Category Number Percent

Vascular Access Type at Latest Treatment among Prevalent In-Center and In-Home Hemodialysis Patients as of December 31, 2015* Arteriovenous Fistula in Use 8,136 66.11

Arteriovenous Graft in Use 1,821 14.8 Catheter in Use for 90 Days or Longer 1,312 10.66

Total 12,306 100 Renal Transplants

Number of Renal Transplant Recipients,* Calendar Year 2015 754 Total 754 100%

Source of data: CROWNWeb. *Count of unduplicated individuals receiving renal transplantation during the calendar year.

9

IMPROVING CARE FOR ESRD PATIENTS

The Network works closely with ESRD patients, patients’ family members and friends, nephrologists, dialysis facilities and other healthcare organizations, ESRD advocacy organizations, and other ESRD stakeholders to improve the care for ESRD patients in the six New England states, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.

Under its contract with CMS, the Network is responsible for:

• Identifying opportunities for quality improvement and developing interventions to improve care for ESRD patients in New England;

• Identifying opportunities for improvement at the facility level and providing technical assistance to facilities as needed;

• Promoting the use of best practices in clinical care for ESRD patients;

• Encouraging use of all modalities of care, including home modalities and transplantation, as appropriate, to promote patient independence and improve clinical outcomes;

• Promoting the coordination of care across treatment settings; and

• Ensuring accurate and timely data collection, analysis, and reporting by facilities in accordance with national standards.

Engaging Patients in Their Healthcare

Patient Advisory Committee (PAC)

The Network is committed to incorporating the perspective of patients and family members into its quality improvement activities. According to the University of Michigan’s Department of Nephrology, “Peer mentors help patients face issues of disease and self-management with difficult treatment regimens. They help patients think through alternatives, cope with depression and anger that are natural to the process. They are positive role models who provide hope, encouragement, and understanding. ”2

2 The University of Michigan’s Department of Nephrology

http://www.med.umich.edu/intmed/nephrology/PATIENTS/peermentors.htm#why

10

In 2015, the Network established a Patient and Family Engagement Learning and Action Network (PFE LAN). A LAN is an ongoing collaboration among community partners who represent a broad range of organizations and professions. Regularly scheduled LAN meetings provide an opportunity for members to share knowledge, skills, and resources to address an identified quality of care issue through collaborative problem solving. Throughout 2015, the PFE LAN was a cohesive unit with active participation of patients and renal professionals, including 11 patients.

Acknowledging the positive impact that peer mentors offer to other patients, the Network focused its efforts on encouraging advocacy champions to join the Network’s Patient Advisory Committee (PAC). With the guidance and support of the PFE LAN, and the continuation of the PAC recruitment campaign, the Network was able to increase the number of PAC representatives from 28 members in 20 facilities at baseline (10.9 % in April 2015) to 70 members representing 49 facilities at re-measurement (26.6% in September 2015). The Network goal was to achieve at least a 10% relative improvement3 in the number of facilities represented by PAC members. The Network exceeded this goal by demonstrating a 15.7 percentage point increase. Network staff teamed up with existing SMEs and PAC members, as a way to overcome geographic barriers, to conduct site visits in facilities lacking a PAC representative. In October 2015, a summit was held to further engage PAC members as peer-to-peer mentors, the model role for those participating in activities, and encourage collaboration among patients and healthcare professionals.

The PFE LAN and PAC members led the development and implementation of the Fluid Management Awareness QIA and Emergency Preparedness Awareness educational campaign. In both projects, re-measurement results far exceeded the desired goals outlined in the project design, thereby reinforcing the importance of incorporating interventions aimed at actively engaging patients in any initiative seeking to improve the overall quality of life and care for people on dialysis.

Fluid Management Awareness

In 2015, the Network implemented a QIA aimed at increasing ESRD patients' awareness of the importance of fluid management by encouraging patients to meet with facility dietitians and clinical staff to discuss dietary guidelines. The goal of the QIA was to achieve at least a 5% relative improvement in patients' understanding management of fluid intake, which could lead to improved health outcomes. Twenty target facilities were selected, based on patient census, to ensure that interventions reached at least 10% of the dialysis patient population in the Network service area (approximately 1,300 patients).

3 The Network defines relative improvement (RI) as: ”The relative change in numerical data is the ratio of the absolute change relative to the initial amount.” http://condor.depaul.edu/scatoiu/tch/AbsoluteRelativeChange.html The Network calculates RI using a standardized formula provided by CMS.

11

Prior to an intervention being initiated, patients in the target facilities were given a test that measured fluid management literacy. Pre-intervention tests yielded an average score of 62.6% comprehension of the concepts of fluid management.. Based on gaps identified in the pre-intervention test results, the Network provided materials—educational poster, cups illustrating fluid ounces for appropriate intake, and patient pledges)—to explain why fluid management is an important clinical component of their treatment plan. Post intervention, patients were asked to complete a follow up knowledge assessment. The results revealed an average score of 78.3% comprehension of the concepts of fluid management. The Network far exceeded its goal, demonstrating a 15.7 percentage point improvement in test scores.

To reinforce the importance of fluid management awareness, the Network encouraged patients to sign a pledge to speak with their dietitians regarding ways to best

manage fluid intake, communicate with their healthcare teams about the removal of fluid, and comply with guidelines set by their physicians. The Network set an internal goal to receive 50 patient fluid management awareness pledges. The Network received 66 patient fluid management awareness pledges, exceeding its goal.

Emergency Preparedness Awareness

Individuals living in New England have the potential to be exposed to many different types of emergencies, particularly weather-related emergencies, which in the past have included hurricanes, blizzards, and flooding. For an ESRD patient, knowing what to do and how to locate dialysis services in an emergency could mean the difference between life and death. To educate, and empower patients about the importance of being prepared, the Network conducted the Emergency Awareness Educational campaign.

The Network selected 42 facilities servicing approximately 2,600 patients to participate in this educational campaign. Patients at the selected facilities were asked to take a test that measured their understanding of the importance of emergency preparedness; the average test score was 53.2%. Based on knowledge gaps that were identified through the test, the Network implemented educational interventions. A post-intervention test was then administered, which yielded an average score of 71.0%—17.8 percentage points higher than the pre-intervention test score. Improvement exceeded the target goal of a 10% increase in emergency preparedness awareness. The Network also asked patients in targeted facilities to sign a pledge to speak with the facility’s emergency coordinator about the facility’s emergency policies, complete all of the emergency-related forms in the CMS booklet Preparing for Emergencies: A Guide for Dialysis Patients, and have their own emergency preparedness kit at home. The Network’s internal goal of receiving 50 patient emergency preparedness awareness pledges was exceeded with the receipt of 209 pledges.

12

Promote Appropriate Home Dialysis in Qualified Patients

The primary focus of the Network selected Population Health Innovation Pilot Project (PHIPP), “Promote Appropriate Home Dialysis in Qualified Patients,” is to reduce an identified disparity while improving the overall home dialysis referral rate in eligible ESRD patients.

The PHIPP emphasizes making care safer by reducing harm caused in the delivery of care; ensuring that each person and family are engaged as partners in the patient’s care; promoting effective communication and coordination of care; promoting the most effective prevention and treatment practices for the leading causes of mortality; working with communities to promote wide use of best practices to enable healthy living; and making quality care more affordable.

ESRD requires choosing between several options for therapy including renal replacement therapies such as in-center or home hemodialysis, peritoneal dialysis, and transplantation. While all renal replacement options offer life-sustaining treatment, home therapies offer the opportunity for better clinical outcomes with reduced mortality and morbidity, improved patient quality of life, and lower cost when compared to long-term hemodialysis.4 Though research has shown that patients are more likely to choose home therapies if information is shared during the early stages of chronic kidney disease (CKD), these conversations do not occur consistently due to a number of factors including timing of referral to nephrology, physician comfort level with home therapy as a modality, and patient education about renal replacement therapy.

Eligibility for home dialysis varies depending on the hemodialysis facility, patient health status, physician perception of patient’s capacity to perform therapy, and living situation. Although these factors influence all patients, there was a noticeably lower number of African Americans versus whites receiving home therapy in the New England area, indicating a disparity in this area, based on 2014 CROWNWeb5 data. Research also revealed that facilities serving higher proportions of minorities tended to lack quality pre-dialysis care, influencing survival after initiation.6

Disparity reduction in healthcare requires a multi-faceted approach addressing both upstream (fundamental) and downstream (intervening) factors. Interventions to improve quality do not always reduce disparities, however, because often all targeted patients improve during the intervention. To avoid this, several key challenges must be addressed: meaningful measurement criteria, proper incentives for providers of care, appropriate site selection, barrier identification, and addressing provider concerns about the disparity.7

4 Neil N, Guest S, Wong L, et al. The financial implications for medicare of greater use of peritoneal dialysis. Clinical therapeutics. 2009;31(4):880–888. 5 Consolidated Renal Operations in a Web-enabled Network, data-collection system that enables Medicare-certified dialysis facilities to securely submit administrative and clinical data to the Centers for Medicare & Medicaid Services (CMS) 6 Hall, Y. N., Xu, P., Chertow, G. M., & Himmelfarb, J. (2014). Characteristics and performance of minority-Serving dialysis facilities. Health Services Research, 49(3), 971-991. doi:10.1111/1475-6773.121444 7 Weinick, R. M., & Hasnain-Wynia, R. (2011). Quality improvement efforts under health reform: How to ensure that they help reduce disparities not increase them. Health Affairs, 30, 1837–1843. doi:10.1377/hlthaff.2011.0617

13

Additionally, patient preferences and expectations of treatment, as well as use of a multi-faceted approach impact use of health services and outcomes.8

Improving referral rates for home therapies requires addressing not only the overall process for referrals, but also the potential issues associated with this disparity in care. Identification of misperceptions about home therapy, barriers to referral, and decreasing gaps sometimes seen between providers and patients help to increase referrals for home therapies and improve patient outcomes associated with therapy that is more frequent.

Facility Identification

Network activities focused on increasing home dialysis referral rates in the eligible population, while demonstrating a reduction in an identified disparity. A disparity assessment hierarchy – ranking of inequalities by race, ethnicity, gender, and age among ESRD patients – was applied to data received from the ESRD National Coordinating Center in February 2015, which identified race as the highest ordered disparity.

CROWNWeb data identified facilities with a home program in place. Facilities were excluded if fewer than three patients were on home dialysis, or if more than 50% of the total population received home dialysis. The Network then conducted a disparity analysis, comparing the remaining facilities’ overall population mix with the population mix of home patients.

To ensure the Network met the goal to reach 5% of the Network’s patient population (13,958), the Network identified nine facilities, with a total of 1,088 patients, for inclusion in the project. These facilities had an overall disparity between eligible adult African American (9.9%) and white (16.4%) home dialysis patients at baseline (July to December 2014). Target facilities had a patient census of more than 75 patients and an African American population greater than 20%.

Interventions to Promote Home Dialysis Referrals

Working with dialysis providers and practitioners throughout the New England area, the Network conducted educational site visits and conference calls and developed the Home Therapies Resource Toolkit. This toolkit included reference materials, resource articles, and helpful decision tools developed by the Medical Education Institute9, as well as handouts with discussion points for patients about therapy options. The Network provided technical assistance and helped facilities to identify best practices in overcoming barriers to referrals to establish new procedures, and improve upon processes already in place for patient referrals. The Network’s Home Therapies Advisory Committee worked to develop, review, and adapt resources for both providers and patients throughout the course of the project, aiding in the effectiveness of information shared with the community, and ensuring that the needs of patients and providers were represented throughout this initiative.

8 Cooper, Lisa A,M.D., M.P.H., Hill, Martha N,R.N., PhD., & Powe, Neil R, MD,M.P.H., M.B.A. (2002). Designing and evaluating interventions to eliminate racial and ethnic disparities in health care. Journal of General Internal Medicine, 17(6), 477-86. 9 Medical Education Institute is a non-profit organization dedicated to helping those with chronic disease management. Additional information can be found at: http://www.homedialysis.org/

14

Outcomes

The Network was able to increase referrals for home dialysis to 75.7% at re-measurement (September 2015). The overall improvement of 59.3 percentage points in the rate of referrals of the identified facility populations to home dialysis modalities far exceeded the goal to increase referrals by 5 percentage points. In addition, the Network was able to decrease the identified disparity gap in referrals by 13.2 percentage points, exceeding the one percentage point goal for reducing the disparity gap.

Figure 1. Home Dialysis Referrals

Increase in Overall Referral Rates

Percentage Point Increase Goal

Baseline Measure

Final Measure

Percentage Point Increase Actual

Referral Rate 5.0 16.4% 75.7% 59.3

Decrease in Referral Disparity Gap

Percentage Point Reduction Goal

Baseline Measure

Final Measure

Percentage Point Reduction Actual

Disparate Gap 1.0 9.9% -3.3% 13.2 Source of data: Network 1 home referral tracking tool. Sustainability

To accomplish these outcomes and ensure sustainability, the Network leveraged partnerships with Large Dialysis Organizations (LDOs), the Advanced Renal Education Program (AREP), a division of Fresenius Medical Care of North America, and NxStage Kidney Care. LDO partners mirrored our initiatives in their corporate programs focusing on increasing home therapies as an option through patient and staff education. AREP provided our community with two face-to-face symposia about home therapies, bringing in speakers from around the country to share their experiences, best practices, and knowledge with dialysis staff. These educational events were intended to assist providers in reducing staff and patient apprehensions about home therapies, while also providing resources, anecdotes, and patient experiences with a variety of dialysis modalities. One speaker, Dr. Robert Lockridge, who is well known in the home therapies arena for his tireless efforts to aid patients in treating at home, was also brought in by AREP to speak at the Annual ESRD Fall Meeting, held as a collaboration between the Network and the American Nephrology Nurses Association (see below for additional details). Dr. Lockridge shared out-of-the-box ideas to aid providers in helping patients to move to a home therapy. NxStage Kidney Care further reinforced these efforts through its patient events across the region and at the Annual ESRD Fall Meeting, having individuals who have successfully dialyzed at home speak with current in-center patients and staff about their experiences, successes, and unique perspectives on dialysis care.

Other Network 1 Activities that Improve Care for ESRD Patients

2015 Educational Symposia for Healthcare Professionals

In addition to its contractual responsibilities, the Network offers the New England dialysis community several educational events throughout the year in various locations within the Network’s service area.

15

In the spring of 2015, the Network hosted two educational meetings for patient care technicians to provide ongoing learning and continuing education units (CEUs) for these frontline staff. Educational topics included the important professional role technicians can play in their facilities related to vascular access, home therapies, water treatment, patient interactions, and infection control. Approximately 150 technicians representing 69 facilities across all six states participated in the meetings. Participants were able to receive seven CEUs toward recertification. Post-meeting evaluations revealed that 80% of attendees rated the meeting as excellent; 80% rated the content as excellent; and that the availability of CEUs and interaction between Network staff and direct care staff were the most important features of these events.

The Annual ESRD Fall Meeting, held in collaboration with two local chapters of the American Nephrology Nurses Association (ANNA), took place on October 27, 2015. This meeting featured a dynamic patient speaker, David Rush, who captivated the audience as he spoke about his experiences touring as a rapper while on dialysis, and throughout the transplant process. The Network received positive feedback from attendees through anonymous evaluations. The meeting hosted more than 400 professionals and renal patients. Speakers touched on important topics that addressed Network goals and challenging issues faced by healthcare professionals on a daily basis. Of those participating and responding to a post-meeting questionnaire, 99% reported that they felt that the meeting met their professional needs, and the same percentage of responders (99%) indicated that they would attend a similar regional meeting next year if given the opportunity. The Network plans to continue its colla-borative approach with local ANNA chapters for future educational meetings.

The meeting, which drew individuals representing multiple disciplines (administrators, dietitians, nurses, pharmacists, physicians, social workers, surveyors, technicians, and other interested healthcare professionals. Attendance was representative of all states within the Network service area and an additional 4% of attendees represented states throughout the country.

Figure 2. Annual ESRD Fall Meeting Attendance

By Discipline

Physicians 10

Nurses 246

Technician 50

Social Worker 33

Dietitian 20

Other 6

Unknown 52

Total 417

Source of data: 2015 meeting registration.

By State

Connecticut 142 Massachusetts 171 Maine 8 New Hampshire 34 Rhode Island 25 Vermont 19 New York 13 Texas 1 Washington 2 Virginia 1 New Jersey 1

Total 417

16

Psychosocial Care Focused Education

Dialysis providers often look to the IPRO ESRD Network of New England for guidance when encountering unique or challenging circumstances in the course of patient care. During 2015, the Network Patient Services department provided education to facilities on a wide range of topics including patient non-adherence, mental health concerns, specialized patient placement, behavioral concerns, cultural considerations, and mediation techniques. The Network has access to numerous agencies and community-based resources, as well as Medical Review Board members and Network Committee members. These stakeholders are called upon as needed to ensure that all possible efforts are made to provide education and to link facility staff to helpful resources. As appropriate, the Network also provides education to facilities on the CMS ESRD Conditions for Coverage as they relate to a given circumstance.

In an effort to educate the ESRD community and strengthen Network activities at the facility level, the following materials were mailed to all dialysis facilities in the Network’s service area:

• Posters, in English and Spanish, explaining patients' rights and responsibilities, and

• Speak Up! grievance posters in English and Spanish, outlining how patients can file a grievance with the Network, their state, and their facility.

Anecdotally, Network staff report that providers positively responded to new materials, as demonstrated by the fact that more than 90% of facilities visited during project implementation have Network-developed posters on display.

Vascular Access Comparative Data Reports

Vascular access summary reports, which were generated by ESRD National Coordinating Center (ESRD NCC), provide national, Network-level, and facility-level data to monitor vascular access rates for improvement. In 2015, the Network enhanced the ESRD NCC vascular access summary reports and sent them to all facilities, via email, using a novel method. This method uses a plug-in for the Adobe Acrobat program. This method eliminated at least $1,000 per mailing in postage fees, as these reports would have previously been sent by certified mail on a monthly basis. It also reduced the time it would take to send the reports via regular mail.. This process change permitted the Network to send vascular access reports to personnel in three facility leadership positions (nurse manager, administrator and medical director) by consolidating the distribution.. These communications increased efficiency, reduced time, decreased cost, and better served the community based on anecdotal feedback received.

The Adobe Acrobat plug-in method was been shared with data managers of all 18 ESRD Networks on a National Community of Practice call hosted by the ESRD NCC. Many data managers have implemented this process in their Networks as a result of the knowledge shared. The Adobe plug-in has also been utilized by the Network in other data management tasks to address missing forms and action items. This resulted in improved compliance with facility clinical reporting requirements. Prior to use of this technique, facility clinical reporting compliance in the Network service area was 89.1% (July 2015), less than the CMS minimum threshold of 95%

17

compliance. Post implementation of this new process, the facility clinical reporting rates increased to 98.9% (September 2015) a 9.8 percentage point difference.

Facilities that Consistently Failed to Cooperate with Network Goals

The Network did not identify any facilities in its service area that failed to cooperate with Network goals.

Recommendations to CMS for Additional Services or Facilities

The Network did not recommend any additional facilities in this region in 2015.

18

GRIEVANCES AND ACCESS TO CARE

IPRO ESRD Network of New England responds to grievances filed by or on behalf of ESRD patients in Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont.

In many instances, the Network works with individual facilities to identify and address difficulties in placing or maintaining patients in treatment. These “access to care” cases may come to the Network’s attention in the form of a grievance or may be initiated by facility staff.

Access to care cases include those involving involuntary discharge, involuntary transfer, and failure to place. An involuntary discharge is a discharge initiated by the treating dialysis facility without the patient’s agreement. An involuntary transfer occurs when the transferring facility temporarily or permanently closes due to a merger, an emergency or disaster situation, or other circumstances and the patient is dissatisfied with the transfer to another facility. A failure to place is defined as a situation in which all local outpatient dialysis facilities have denied the patient acceptance for routine dialysis treatment.

In 2015, the Network responded to 22 grievances. The Network responded to 12 additional non-grievance access to care cases brought to the Network’s attention by facility staff. The Network worked with 12 “at risk” (for discharge/transfer) patients and their dialysis facilities. Through Network interventions, these cases were resolved without the facility having to move forward with an involuntary discharge or any other action. Additionally, the Network assisted facilities with one “lost to follow up” case and six potential involuntary discharges that were averted as a result of the Network’s intervention. The Network also responded to one failure to place case in 2015.

Table D. Grievance Data for Calendar Year 2015

Category Number

Number of Grievance Cases Opened by the Network in Calendar Year 2015* 22 Number (Percent) of Grievance Cases Involving Access to Care 1 (0.05%)

Number of Grievance Cases Involving Involuntary Transfer 0 Number of Grievance Cases Involving Involuntary Discharge 0

Number of Grievance Cases Involving Failure to Place 1 Number of Non-Grievance Cases Involving Access to Care 12

Number of Non-Grievance Access to Care Cases Involving Involuntary Transfer 0 Number of Non-Grievance Access to Care Cases Involving Involuntary Discharge 12 Number of Non-Grievance Access to Care Cases Involving Failure to Place 0

Total Number of Grievance and Non-Grievance Cases Involving Access to Care 13 Number of Grievance Cases Closed by the Network in Calendar Year 2015 19

Number of Non-Grievance Access to Care Cases Closed by the Network in Calendar Year 2015 12 Source of data: Patient Contact Utility *Includes grievance cases involving access to care. **Includes grievance cases involving access to care as well as non-grievance access to care cases.

19

Grievance Cases Referred to State Survey Agencies

The Network referred three cases to State Survey Agencies (SAs) in 2015. A patient requesting financial reimbursement from his facility filed the first case, which was referred to the SA. The patient fainted after receiving treatment and broke his tooth. The SA investigated the clinical components of this case. A patient who reported that the facility was constantly out of supplies and that its chairs were old and caused him to have back pain filed the second case. The patient requested an on-site investigation by the SA. The case was resolved and closed by the Network in June. The third case was filed by a patient requesting an on-site visit regarding alleged fraudulent medical billing and lack of staff competency regarding training and education. This was referred to the appropriate SA and closed by the Network in July.

Positive Enhancement Communication Sessions (PECS)

In order to identify a systemic issue or trend in grievances received at the Network level, the Network used the Patient Contact Utility (PCU) to conduct a focused audit of all grievances filed during the four quarters of 2014 and the first quarter of 2015. An analysis of the data revealed a prevalence of grievances filed pertaining to communication between patients and staff members at the facility level. A grievance QIA was developed, and interventions were implemented, to address the identified concerns surrounding deficiencies in communication and professionalism. The primary goal of the QIA was to decrease the number of topic area grievances, from baseline (January–March) through monthly re-measurement (May-September).

The target facilities, with a total census of 514 patients, were selected based on the five grievances filed during the baseline period. Zero topic area grievances were reported in these facilities throughout the QIA, resulting in the Network having met the primary project goal.

To foster open communication, patients and dialysis staff members were encouraged to participate in Positive Enhancement Communication Sessions (PECS) or “interviews” developed by the Network. Interview questions were carefully composed to protect the privacy of both parties. Informal meetings were set up between patients and staff to conduct the five- to seven-minute interviews. Participants learned how to “humanize” each other, rather than using labels such as a “patient” or “healthcare provider." After participating in PECS, both patients and staff signed pledges committing to ongoing positive communication and promoting long-term behavioral changes. The Network received 64 pledges from patients and staff within the five target facilities, exceeding the original goal of 50 pledges.

The intent of this QIA was to create opportunities for meaningful and positive communication. Feedback collected following PECS completion confirmed that the interventions had succeeded in helping patients and providers to communicate with one another on a more personal level, creating a more comfortable and open environment.

20

EMERGENCY PREPAREDNESS AND RESPONSE

For individuals who have been diagnosed with ESRD, missed dialysis treatments can have serious adverse health effects. This makes the ESRD patient population especially vulnerable during emergencies and disasters. The Network relies on longstanding partnerships with state and city health departments, offices of emergency management, and regional/national emergency preparedness coalitions to ensure safety and continuity of care for ESRD patients throughout New England. During 2015, the Network coordinated region-wide emergency preparedness and response for the New England dialysis community.

Emergency Events During 2015

In all reported emergencies, the Network offers comprehensive support and links providers with resources and other stakeholders as needed. The Network successfully assessed, responded to, and tracked 11 emergency events during 2015. In total, 137 facilities and 10,214 dialysis patients were directly impacted. These events accounted for 91 total days of facility closures and/or schedule alterations. In emergency events, the Network staff members are trained to:

• Evaluate the affected area to assess impact;

• Release email or fax blasts notifying dialysis facilities and response agencies in the affected area of the occurrence;

• Provide dialysis facilities, patients, and family members with information on appropriate local resources;

• Connect facilities and individual patients, families, and care partners with appropriate local resources;

• Participate in emergency meetings with local offices of emergency management and the state health departments; and

• Measure and quantify the impact of the occurrence.

Figure 3. 2015 Emergency Events Requiring Network Intervention

Type of Event

Number

of Occurrences

Number of Facilities Impacted

Number of ESRD Patients

Impacted

Number of Facilities with

Closures / Altered

Treatment Schedules*

Snow events 5 131 9,817 90 Hurricane/tornado watches 3 0 0 0

21

Type of Event

Number

of Occurrences

Number of Facilities Impacted

Number of ESRD Patients

Impacted

Number of Facilities with

Closures / Altered

Treatment Schedules*

Water main break 1 2 221 0

Increased levels of Chloramine and PH in water supply 1 3 173 0

Shootings 1 1 3 1 Source of date: facility reported *Delayed opening or early closure of facilities

Emergency Activity Highlight

Winter Storm Juno (January 26-27, 2015)

• Winter storm Juno was a widespread blizzard that affected 109 dialysis facilities in the Network service area. The total patient population in the affected facilities was 4,758. Of the affected facilities, 99 reported complete closures and 10 delayed openings or altered treatment as a result of the storm. Network staff members were equally affected by the storm; unable to travel the Network office, staff worked remotely on January 26 and 27. Throughout the course of the storm, Network staff held regular conference calls to coordinate facility tracking and address emerging issues, as well as participated in daily calls with the Kidney Community Emergency Response (KCER) program. During the event, the Network was made aware of several patient access to care barriers regarding transportation. Through collaboration with local offices of emergency management, alternate transportation services were provided.

22

LIST OF DATA TABLES Table 1. Incident (New) ESRD Patients in Network 1's Service Area, by Patient Characteristics

Table 2. Prevalent Dialysis Patients in Network 1's Service Area, by Patient Characteristics

Table 3A. In-Home Dialysis Patients In Network 1's Service Area, by State and Modality

Table 3B. In-Home Dialysis Patients In Network 1's Service Area, by State, Dialysis Facility and Modality

Table 4A. In-Center Dialysis Patients in Network 1's Service Area, by State and Modality

Table 4B. In-Center Dialysis Patients in Network 1's Service Area, by State, Dialysis Facility and Modality

Table 5. Number of Transplants Performed in Network 1's Service Area, by Transplant Center and Donor Type and Number of Patients on Transplant Waiting List* in Network 1's Service Area, by Transplant Center

Table 6. Renal Transplant* Recipients in Network 1’s Service Area, by Patient Characteristics

Table 7. Deaths among Dialysis Patients in Network 1’s Service Area, by Patient Characteristics

Table 8A. Vocational Rehabilitation Status, Employment Status, and School Attendance of Prevalent Dialysis Patients Age 18–54 Years by Facility in Network 1’s Service Area

Table 8B. Vocational Rehabilitation Status, Employment Status, and School Attendance of Prevalent Dialysis Patients Age 18-54 Years in Network 1's Service Area

Table 9A. Incident ESRD Patients in Network 1’s Service Area, by Ethnicity and Race

Table 9B. Prevalent Dialysis Patients in Network 1’s Service Area, by Ethnicity and Race

Table 9C. Renal Transplant Recipients* in Network 1’s Service Area, by Ethnicity and Race

23

DATA TABLES

Table 1. Incident (New) ESRD Patients in Network 1's Service Area, by Patient Characteristics (January 1, 2015 - December 31, 2015)

Network 1's Service Area CT MA ME NH RI VT Other Total

Age Group

<= 4 Years 2 6 0 0 0 0 2 10 5-9 Years 1 2 0 0 0 0 0 3 10-14 Years 0 4 0 0 0 0 1 5 15-19 Years 6 4 3 0 1 0 2 16 20-24 Years 4 19 1 0 2 0 0 26 25-29 Years 15 16 3 1 4 1 4 44 30-34 Years 14 34 4 3 5 4 1 65 35-39 Years 30 39 10 5 7 2 4 97 40-44 Years 36 56 10 7 11 4 2 126 45-49 Years 56 102 17 12 19 2 6 214 50-54 Years 83 133 35 24 32 9 4 320 55-59 Years 122 180 22 26 21 11 8 390 60-64 Years 146 192 47 35 36 12 4 472 65-69 Years 145 266 60 37 48 17 12 585 70-74 Years 110 252 51 33 26 19 6 497 75-79 Years 89 201 36 39 36 17 8 426 80-84 Years 118 218 21 33 34 12 6 442 >= 85 Years 70 136 8 10 29 3 1 257

Total 1,047 1,860 328 265 311 113 71 3,995 Median Age 65 67 65 68 67 69 62 66

Gender Female 437 725 132 96 126 45 27 1,588 Male 610 1135 196 169 185 68 44 2,407

Total 1,047 1,860 328 265 311 113 71 3,995

Ethnicity* Hispanic or Latino 135 169 0 2 28 1 7 342 Not Hispanic or Latino 912 1,674 328 263 283 112 64 3,636 Not Specified 0 17 0 0 0 0 0 17

Total 1,047 1,860 328 265 311 113 71 3,995

Race* American Indian/Alaska Native 0 2 1 0 1 0 0 4 Asian 26 69 2 6 5 3 2 113 Black or African American 251 264 9 3 40 3 14 584

24


Native Hawaiian or Other Pacific Islander 5 4 1 0 2 0 1 13 White 764 1,498 314 256 262 107 54 3,255 More Than One Race Reported 1 6 1 0 1 0 0 9 Not Specified 0 17 0 0 17

Total 1,047 1,860 328 265 311 113 71 3,995

Primary Cause of ESRD*

Diabetes 454 782 143 101 138 52 30 1,700 Glomerulonephritis 111 132 26 27 28 6 4 334 Secondary Glomerulonephritis/Vasculitis 21 50 9 11 7 3 3 104 Interstitial Nephritis/Pyelonephritis 46 82 12 13 14 7 3 177 Transplant Complications 0 2 0 2 1 1 0 6 Hypertension/Large Vessel Disease 232 429 61 51 70 17 15 875 Cystic/Hereditary/Congenital/Other Diseases 48 101 20 11 8 5 5 198 Neoplasms/Tumors 28 65 11 11 10 3 2 130 Disorders of Mineral Metabolism 0 1 1 0 0 0 0 2 Genitourinary System 1 3 0 0 0 1 0 5 Acute Kidney Failure 8 11 3 3 2 0 0 27 Miscellaneous Conditions 90 166 39 31 33 15 8 382 Not Specified 8 36 3 4 3 1 55

Total 1,047 1,860 328 265 311 113 71 3,995 Source of data: CROWNWeb *Categories are from the CMS-2728 form. NOTES: 1. This table includes data on dialysis and transplant patients whose initial “Admit Date” in CROWNWeb was within the calendar year (January 1, 2015 to December 31, 2015). It excludes patients with a "Discharge Reason" of acute kidney failure. 2. This table may include data on some patients receiving dialysis services from U.S. Department of Veterans Affairs (VA) facilities. 3. Data on "ethnicity" and "race" should be interpreted with caution because of the inherent instability of race/ethnicity data.

25

Table 2. Prevalent Dialysis Patients in Network 1's Service Area, by Patient Characteristics (January 1, 2015 - December 31, 2015)


Age Group

<= 4 Years 2 4 0 0 0 0 0 6 5-9 Years 0 2 0 0 0 0 1 3 10-14 Years 1 2 0 0 0 0 1 4 15-19 Years 7 5 3 0 3 0 1 19 20-24 Years 18 49 3 9 5 1 2 87 25-29 Years 47 86 11 10 11 4 2 171 30-34 Years 58 115 15 15 23 4 7 237 35-39 Years 120 154 22 20 30 6 5 357 40-44 Years 163 230 33 38 44 10 11 529 45-49 Years 260 384 48 63 71 15 18 859 50-54 Years 389 514 86 71 91 16 10 1,177 55-59 Years 458 714 101 102 113 33 22 1,543 60-64 Years 555 729 153 131 121 28 23 1,740 65-69 Years 518 869 170 123 156 41 15 1,892 70-74 Years 444 793 132 108 126 46 22 1,671 75-79 Years 383 646 107 96 108 46 14 1,400 80-84 Years 335 586 68 97 110 28 6 1,230 >= 85 Years 277 465 54 63 94 30 15 998

Total 4,035 6,347 1,006 946 1,106 308 175 13,923 Median Age 64 66 65 65 66 69 62 65

Gender Female 1,687 2,593 422 386 468 119 65 5,740 Male 2,348 3,754 584 560 638 189 110 8,183

Total 4,035 6,347 1,006 946 1,106 308 175 13,923

Ethnicity* Hispanic or Latino 575 785 1 25 130 0 38 1,554 Not Hispanic or Latino 3,460 5,558 1,005 921 976 308 137 12,365 Not Specified 0 4 0 0 0 0 0 4

Total 4,035 6,347 1,006 946 1,106 308 175 13,923

Race* American Indian/Alaska Native 5 11 5 0 4 0 0 25 Asian 77 293 13 17 32 4 4 440 Black or African American 1,421 1,334 29 25 169 9 43 3,030 Native Hawaiian or Other Pacific Islander 26 20 0 2 11 0 0 59 White 2,503 4,667 956 901 882 295 128 10,332

26


More Than One Race Reported 3 19 3 1 8 0 0 34 Not Specified 0 3 0 0 0 0 0 3

Total 4,035 6,347 1,006 946 1,106 308 175 13,923


Diabetes 1,695 2,638 437 381 447 140 78 5,816 Glomerulonephritis 473 706 94 101 134 28 15 1,551 Secondary Glomerulonephritis/ Vasculitis 99 193 30 26 23 10 5 386 Interstitial Nephritis/Pyelonephritis 166 289 52 51 50 24 6 638 Transplant Complications 1 1 0 2 1 0 0 5 Hypertension/Large Vessel Disease 928 1,429 181 175 239 48 38 3,038 Cystic/Hereditary/Congenital/ Other Diseases 190 307 74 67 48 17 10 713 Neoplasms/Tumors 160 306 50 48 68 14 9 655 Disorders of Mineral Metabolism 0 1 0 0 0 0 0 1 Genitourinary System 0 3 0 0 0 1 0 4 Acute Kidney Failure 8 10 3 3 1 0 0 25 Miscellaneous Conditions 298 444 82 86 92 26 14 1,042 Not Specified 17 20 3 6 3 49

Total 4,035 6,347 1,006 946 1,106 308 175 13,923 Source of data: CROWNWeb *Categories are from the CMS-2728 form. NOTES: 1. This table includes data on all patients identified in CROWNWeb as "Alive and Receiving Dialysis Services" as of December 31, 2015. 2. This table may include data on some patients receiving dialysis services from U.S. Department of Veterans Affairs (VA) facilities. 3. Data on "ethnicity" and "race" should be interpreted with caution because of the inherent instability of race/ethnicity data.

27

Table 3A. In-Home Dialysis Patients in Network 1's Service Area, by State and Modality (as of December 31, 2015)

State HD CAPD CCPD Other

Modalities

Total In-Home

Patients

Total In-Center and

In-Home Patients

CT 80 113 451 1 645 4,116 MA 92 92 436 0 620 6,421 ME 21 25 60 0 106 1,024 NH 21 8 80 0 109 939 RI 4 9 38 0 51 1,120 VT 13 4 13 0 30 327 Network Total 231 251 1,078 1 1,561 13,947

Source of data: ESRD Facility Survey (CMS-2744A) as recorded in CROWNWeb HD = Hemodialysis CAPD = Continuous Ambulatory Peritoneal Dialysis CCPD = Continuous Cycling Peritoneal Dialysis NOTE: This table may include data for some U.S. Department of Veterans Affairs (VA) facilities.

28

Table 3B. In-Home Dialysis Patients in Network 1's Service Area by State, Dialysis Facility and Modality (as of December 31, 2015)

Facility CCN HD CAPD CCPD Other

Modalities

Total In-Home

Patients

Total In-Center and

In-Home Patients

Connecticut 070022 0 0 0 0 0 0 070025 0 4 2 0 6 170 070025 0 0 0 0 0 0 070035 0 0 15 0 15 110 07003F 0 0 0 0 0 36 072501 4 10 69 0 83 320 072503 0 13 42 0 55 55 072504 6 3 25 1 35 186 072505 0 2 2 0 4 51 072506 0 0 1 0 1 40 072507 10 9 39 0 58 153 072508 0 0 2 0 2 42 072509 1 3 20 0 24 109 072510 0 0 0 0 0 100 072511 0 9 39 0 48 178 072512 8 0 0 0 8 179 072514 0 0 0 0 0 89 072515 6 1 14 0 21 125 072516 0 5 16 0 21 153 072517 0 0 0 0 0 54 072518 13 4 4 0 21 68 072519 2 10 8 0 20 88 072520 0 4 13 0 17 105 072521 0 10 13 0 23 154 072522 0 0 0 0 0 64 072523 0 1 21 0 22 76 072524 0 3 6 0 9 98 072527 0 0 7 0 7 56 072528 5 0 11 0 16 80 072529 0 0 15 0 15 87 072530 0 0 0 0 0 42 072531 0 2 3 0 5 54 072532 0 0 0 0 0 55 072533 21 0 0 0 21 87 072534 1 1 1 0 3 43 072535 0 0 0 0 0 82

29


Modalities

Total In-Home

Patients

Total In-Center and

In-Home Patients

072536 0 0 3 0 3 40 072537 0 0 0 0 0 83 072538 0 2 9 0 11 67 072539 3 1 19 0 23 113 072540 0 1 9 0 10 59 072541 0 1 1 0 2 38 072542 0 5 8 0 13 69 072543 0 1 2 0 3 53 072544 0 6 7 0 13 136 072545 0 0 2 0 2 24 072546 0 0 0 0 0 19 072547 0 0 3 0 3 16 072548 0 2 0 0 2 10 072549 0 0 0 0 0 0

CT Total 80 113 451 1 645 4,116

Massachusetts 220028 0 0 19 0 19 77 220031 0 0 0 0 0 0 220036 0 1 3 0 4 93 220046 3 3 11 0 17 121 220071 0 8 13 0 21 28 220071 0 0 0 0 0 0 220077 0 0 0 0 0 0 220081 0 0 0 0 0 2 220086 0 0 0 0 0 0 22010F 0 0 0 0 0 21 220110 0 0 0 0 0 3 220110 0 0 0 0 0 0 220116 0 0 0 0 0 0 220123 0 0 0 0 0 10 220163 0 0 0 0 0 0 220163 0 0 0 0 0 1 220171 0 0 0 0 0 0 221302 0 0 0 0 0 20 222006 0 0 0 0 0 0 222500 0 0 3 0 3 95 222501 5 1 5 0 11 84 222502 0 0 0 0 0 121 222503 0 5 3 0 8 126

30


Modalities

Total In-Home

Patients

Total In-Center and

In-Home Patients

222504 3 3 5 0 11 118 222505 0 0 0 0 0 72 222506 0 0 0 0 0 92 222507 4 0 0 0 4 113 222508 0 0 0 0 0 96 222511 0 0 0 0 0 82 222512 0 1 4 0 5 114 222513 0 1 16 0 17 79 222515 1 0 6 0 7 94 222516 0 0 9 0 9 129 222517 8 2 6 0 16 136 222519 0 0 0 0 0 76 222520 0 4 9 0 13 83 222521 1 1 14 0 16 100 222523 0 3 8 0 11 129 222524 0 0 0 0 0 83 222525 0 0 0 0 0 111 222526 0 10 46 0 56 263 222529 10 7 20 0 37 171 222530 2 2 5 0 9 91 222532 0 0 0 0 0 0 222533 0 3 3 0 6 66 222534 0 3 9 0 12 74 222535 0 0 0 0 0 49 222536 0 2 12 0 14 116 222537 0 0 0 0 0 55 222538 7 0 0 0 7 131 222539 0 1 6 0 7 51 222542 6 2 5 0 13 98 222543 0 0 5 0 5 111 222545 6 5 10 0 21 118 222546 0 0 5 0 5 97 222548 0 0 0 0 0 17 222549 4 3 34 0 41 125 222550 5 0 8 0 13 124 222551 0 1 4 0 5 106 222552 0 8 30 0 38 166 222553 0 1 8 0 9 57 222556 0 4 5 0 9 100

31


Modalities

Total In-Home

Patients

Total In-Center and

In-Home Patients

222557 0 0 0 0 0 36 222559 0 0 0 0 0 44 222560 0 0 0 0 0 75 222561 0 0 0 0 0 88 222562 0 0 1 0 1 58 222564 9 1 21 0 31 161 222565 3 1 3 0 7 112 222567 0 0 7 0 7 74 222568 0 0 0 0 0 49 222570 3 0 7 0 10 68 222571 2 1 16 0 19 88 222572 0 0 0 0 0 67 222573 1 1 2 0 4 108 222574 0 1 2 0 3 92 222576 0 0 0 0 0 55 222577 0 0 3 0 3 31 222578 0 0 0 0 0 9 222579 3 0 4 0 7 39 222580 0 0 0 0 0 49 222581 0 0 2 0 2 22 222582 0 0 0 0 0 90 222583 0 0 10 0 10 221 222584 0 0 0 0 0 46 222585 1 2 1 0 4 11 222586 5 0 1 0 6 9 222587 0 0 0 0 0 0 223302 0 0 0 0 0 0 223302 0 0 7 0 7 19 223504 0 0 0 0 0 5

MA Total 92 92 436 0 620 6,421

Maine 200009 0 0 0 0 0 0 200018 0 0 0 0 0 52 20003F 0 0 0 0 0 18 202500 7 3 17 0 27 105 202501 0 0 0 0 0 55 202502 2 0 2 0 4 52 202503 1 1 11 0 13 84 202504 0 1 1 0 2 77

32


Modalities

Total In-Home

Patients

Total In-Center and

In-Home Patients

202505 0 0 0 0 0 79 202506 2 4 7 0 13 75 202507 1 0 1 0 2 26 202508 0 0 2 0 2 31 202509 0 0 0 0 0 34 202510 1 1 1 0 3 18 202511 0 2 1 0 3 32 202512 7 13 10 0 30 143 202513 0 0 0 0 0 32 202514 0 0 0 0 0 49 202515 0 0 7 0 7 62

ME Total 21 25 60 0 106 1,024

New Hampshire 300003 0 0 0 0 0 0 302500 11 0 2 0 13 82 302501 0 1 29 0 30 83 302502 0 1 12 0 13 115 302503 0 0 0 0 0 40 302504 0 0 0 0 0 56 302505 0 0 0 0 0 70 302506 0 0 0 0 0 40 302507 5 3 20 0 28 117 302508 0 0 0 0 0 28 302509 5 0 5 0 10 92 302510 0 0 0 0 0 34 302511 0 0 2 0 2 23 302512 0 1 0 0 1 24 302513 0 1 7 0 8 26 302514 0 0 0 0 0 44 302515 0 0 0 0 0 24 302516 0 1 3 0 4 27 302517 0 0 0 0 0 14

NH Total 21 8 80 0 109 939

Rhode Island 410007 0 0 0 0 0 0 41002F 0 0 0 0 0 38 412501 3 0 2 0 5 116 412502 0 0 0 0 0 40 412503 0 0 0 0 0 69

33


Modalities

Total In-Home

Patients

Total In-Center and

In-Home Patients

412504 0 0 0 0 0 99 412505 1 3 4 0 8 119 412506 0 2 6 0 8 63 412507 0 0 0 0 0 39 412508 0 0 0 0 0 77 412509 0 0 0 0 0 43 412510 0 0 0 0 0 64 412511 0 0 0 0 0 71 412512 0 0 10 0 10 74 412514 0 0 0 0 0 69 413500 0 4 16 0 20 106 413501 0 0 0 0 0 33

RI Total 4 9 38 0 51 1,120

Vermont 470003 0 0 0 0 0 0 470003 0 0 0 0 0 5 472500 0 0 0 0 0 45 472501 0 0 0 0 0 31 473500 0 0 0 0 0 33 473501 0 0 0 0 0 44 473502 0 0 0 0 0 41 473503 13 4 13 0 30 111 473504 0 0 0 0 0 17

VT Total 13 4 13 0 30 327 Source of data: ESRD Facility Survey (CMS-2744A) as recorded in CROWNWeb HD = Hemodialysis CAPD = Continuous Ambulatory Peritoneal Dialysis CCPD = Continuous Cycling Peritoneal Dialysis NOTE: This table may include data for some U.S. Department of Veterans Affairs (VA) facilities.

34

Table 4A. In-Center Dialysis Patients in Network 1's Service Area, by State and Modality as of December 31, 2015

State HD PD Total In-Center

Patients

Total In-Center and In-Home

Patients

CT 3,467 4 3,471 4,116 MA 5,794 7 5,801 6,421 ME 918 0 918 1,024 NH 830 0 830 939 RI 1,069 0 1,069 1,120 VT 297 0 297 327

Network Total 12,375 11 12,386 13,947 Source of data: ESRD Facility Survey (CMS-2744A) as recorded in CROWNWeb HD = Hemodialysis PD = Peritoneal Dialysis Note: This table may include data for some IU.S. Department of Veterans Affairs (VA) facilities.

35

Table 4B. In-Center Dialysis Patients in Network 1's Service Area, by State, Dialysis Facility and Modality (as of December 31, 2015)

Facility CCN HD PD Total In-Center

Patients Total In-Center and In-Home Patients

Connecticut 070022 0 0 0 0 070025 164 0 164 170 070025 0 0 0 0 070035 95 0 95 110 07003F 36 0 36 36 072501 237 0 237 320 072503 0 0 0 55 072504 149 2 151 186 072505 47 0 47 51 072506 39 0 39 40 072507 95 0 95 153 072508 40 0 40 42 072509 85 0 85 109 072510 100 0 100 100 072511 130 0 130 178 072512 171 0 171 179 072514 89 0 89 89 072515 104 0 104 125 072516 132 0 132 153 072517 54 0 54 54 072518 47 0 47 68 072519 68 0 68 88 072520 87 1 88 105 072521 131 0 131 154 072522 64 0 64 64 072523 54 0 54 76 072524 88 1 89 98 072527 49 0 49 56 072528 64 0 64 80 072529 72 0 72 87 072530 42 0 42 42 072531 49 0 49 54 072532 55 0 55 55 072533 66 0 66 87 072534 40 0 40 43 072535 82 0 82 82 072536 37 0 37 40 072537 83 0 83 83

36



072538 56 0 56 67 072539 90 0 90 113 072540 49 0 49 59 072541 36 0 36 38 072542 56 0 56 69 072543 50 0 50 53 072544 123 0 123 136 072545 22 0 22 24 072546 19 0 19 19 072547 13 0 13 16 072548 8 0 8 10 072549 0 0 0 0

CT Total 3,467 4 3,471 4,116

Massachusetts 220028 58 0 58 77 220031 0 0 0 0 220036 88 1 89 93 220046 104 0 104 121 220071 6 1 7 28 220071 0 0 0 0 220077 0 0 0 0 220081 2 0 2 2 220086 0 0 0 0 22010F 21 0 21 21 220110 3 0 3 3 220110 0 0 0 0 220116 0 0 0 0 220123 10 0 10 10 220163 0 0 0 0 220163 1 0 1 1 220171 0 0 0 0 221302 20 0 20 20 222006 0 0 0 0 222500 92 0 92 95 222501 73 0 73 84 222502 121 0 121 121 222503 118 0 118 126 222504 107 0 107 118 222505 72 0 72 72 222506 92 0 92 92 222507 109 0 109 113

37



222508 96 0 96 96 222511 82 0 82 82 222512 109 0 109 114 222513 62 0 62 79 222515 87 0 87 94 222516 120 0 120 129 222517 120 0 120 136 222519 76 0 76 76 222520 70 0 70 83 222521 84 0 84 100 222523 118 0 118 129 222524 83 0 83 83 222525 111 0 111 111 222526 203 4 207 263 222529 134 0 134 171 222530 82 0 82 91 222532 0 0 0 0 222533 60 0 60 66 222534 62 0 62 74 222535 49 0 49 49 222536 102 0 102 116 222537 55 0 55 55 222538 124 0 124 131 222539 44 0 44 51 222542 85 0 85 98 222543 106 0 106 111 222545 97 0 97 118 222546 92 0 92 97 222548 17 0 17 17 222549 84 0 84 125 222550 111 0 111 124 222551 101 0 101 106 222552 128 0 128 166 222553 48 0 48 57 222556 91 0 91 100 222557 36 0 36 36 222559 44 0 44 44 222560 75 0 75 75 222561 88 0 88 88 222562 57 0 57 58 222564 130 0 130 161

38



222565 105 0 105 112 222567 67 0 67 74 222568 49 0 49 49 222570 58 0 58 68 222571 69 0 69 88 222572 67 0 67 67 222573 104 0 104 108 222574 89 0 89 92 222576 55 0 55 55 222577 28 0 28 31 222578 9 0 9 9 222579 32 0 32 39 222580 49 0 49 49 222581 20 0 20 22 222582 90 0 90 90 222583 211 0 211 221 222584 46 0 46 46 222585 6 1 7 11 222586 3 0 3 9 222587 0 0 0 0 223302 0 0 0 0 223302 12 0 12 19 223504 5 0 5 5

MA Total 5,794 7 5,801 6,421

Maine 200009 0 0 0 0 200018 52 0 52 52 20003F 18 0 18 18 202500 78 0 78 105 202501 55 0 55 55 202502 48 0 48 52 202503 71 0 71 84 202504 75 0 75 77 202505 79 0 79 79 202506 62 0 62 75 202507 24 0 24 26 202508 29 0 29 31 202509 34 0 34 34 202510 15 0 15 18 202511 29 0 29 32 202512 113 0 113 143

39



202513 32 0 32 32 202514 49 0 49 49 202515 55 0 55 62

ME Total 918 0 918 1,024

New Hampshire 300003 0 0 0 0 302500 69 0 69 82 302501 53 0 53 83 302502 102 0 102 115 302503 40 0 40 40 302504 56 0 56 56 302505 70 0 70 70 302506 40 0 40 40 302507 89 0 89 117 302508 28 0 28 28 302509 82 0 82 92 302510 34 0 34 34 302511 21 0 21 23 302512 23 0 23 24 302513 18 0 18 26 302514 44 0 44 44 302515 24 0 24 24 302516 23 0 23 27 302517 14 0 14 14

NH Total 830 0 830 939

Rhode Island 410007 0 0 0 0 41002F 38 0 38 38 412501 111 0 111 116 412502 40 0 40 40 412503 69 0 69 69 412504 99 0 99 99 412505 111 0 111 119 412506 55 0 55 63 412507 39 0 39 39 412508 77 0 77 77 412509 43 0 43 43 412510 64 0 64 64 412511 71 0 71 71 412512 64 0 64 74 412514 69 0 69 69

40



413500 86 0 86 106 413501 33 0 33 33

RI Total 1,069 0 1,069 1,120

Vermont 470003 0 0 0 0 470003 5 0 5 5 472500 45 0 45 45 472501 31 0 31 31 473500 33 0 33 33 473501 44 0 44 44 473502 41 0 41 41 473503 81 0 81 111 473504 17 0 17 17

VT Total 297 0 297 327 Source of data: ESRD Facility Survey (CMS-2744A) as recorded in CROWNWeb HD = Hemodialysis CAPD = Continuous Ambulatory Peritoneal Dialysis CCPD = Continuous Cycling Peritoneal Dialysis NOTE: This table may include data for some U.S. Department of Veterans Affairs (VA) facilities.

41

Table 5. Number of Transplants Performed in Network 1's Service Area, by Transplant Center and Donor Type and Number of Patients on Transplant Waiting List* in Network 1's Service Area, by Transplant Center (January 1, 2015 - December 31, 2015)

Transplant Center CCN

Deceased Donor

Living Related Donor

Living Unrelated

Donor

Unknown Donor Type

Total Transplants Performed

Patients on Transplant

Waiting List

070022 52 20 33 0 105 190 070025 35 9 12 0 56 334

CT Total 87 29 45 0 161 524 220031 31 7 0 0 38 167 220071 69 24 33 0 126 125 220077 7 10 3 0 20 136 220086 49 6 12 0 67 136 220110 28 16 17 0 61 0 220116 15 8 10 0 33 0 220163 32 7 7 0 46 261 220171 11 3 9 0 23 165 223302 8 13 5 0 26 0

MA Total 250 94 96 0 440 990 200009 17 7 20 0 44 0

ME Total 17 7 20 0 44 0 300003 27 8 14 0 49 93

NH Total 27 8 14 0 49 93 410007 40 4 2 0 46 151

RI Total 40 4 2 0 46 151 470003 16 0 0 0 16 78

VT Total 16 0 0 0 16 78 Network Total 437 142 177 0 756 1,836

Source of data: CROWNWeb; Information on patients awaiting transplant comes from the ESRD Facility Survey completed by transplant centers (Form CMS-2744B). *As of December 31, 2015 NOTE: Cumulative total for January 1, 2015 – December 31, 2015. A patient who had more than one transplant during the calendar year is represented more than once in the table.

42

Table 6. Renal Transplant* Recipients in Network 1’s Service Area, by Patient Characteristics (January 1, 2015 - December 31, 2015)


Age Group


Total 155 383 51 57 50 23 35 754 Median Age 52 51 55 53 51 56 43 52

Gender Female 50 150 19 25 22 10 14 290 Male 105 233 32 32 28 13 21 464

Total 155 383 51 57 50 23 35 754

Ethnicity* Hispanic or Latino 19 52 1 2 13 0 4 91 Not Hispanic or Latino 135 311 50 55 37 23 31 642 Not Specified 1 20 0 0 0 0 0 21

Total 155 383 51 57 50 23 35 754

Race* American Indian/Alaska Native 0 0 0 0 0 0 0 0 Asian 6 20 1 1 4 1 0 33 Black or African American 37 64 0 1 8 1 3 114 Native Hawaiian or Other Pacific Islander 0 3 0 0 1 0 0 4 White 110 276 50 55 37 21 32 581 More Than One Race Reported 1 1 0 0 0 0 0 2

43


Not Specified 1 19 0 0 0 0 0 20 Total 155 383 51 57 50 23 35 754


Diabetes 27 66 7 14 9 5 9 137 Glomerulonephritis 42 89 10 15 13 6 3 178 Secondary Glomerulonephritis/Vasculitis 6 19 2 0 3 1 2 33 Interstitial Nephritis/Pyelonephritis 6 26 3 5 1 0 3 44 Transplant Complications 0 0 0 0 0 0 0 0 Hypertension/Large Vessel Disease 23 47 7 3 8 2 5 95 Cystic/Hereditary/Congenital/ Other Diseases 31 65 11 8 4 3 7 129 Neoplasms/Tumors 8 17 5 4 8 1 2 45 Disorders of Mineral Metabolism 0 0 0 0 0 0 0 0 Genitourinary System 0 0 0 0 0 0 0 0 Acute Kidney Failure 0 1 0 0 0 0 0 1 Miscellaneous Conditions 11 28 5 8 4 2 3 61 Not Specified 1 25 1 0 0 3 1 31

Total 155 383 51 57 50 23 35 754 Source of data: CROWNWeb *Data are shown for unduplicated patients. A patient who had more than one transplant during the calendar year is counted only once in the table. **Categories are from the CMS-2728 form. NOTE: Data on “ethnicity” and “race” should be interpreted with caution because of the inherent instability of race/ethnicity data.

44

Table 7. Deaths Among Dialysis Patients in Network 1’s Service Area, by Patient Characteristics

Network 1's Service Area

CT MA ME NH RI VT Other Total

Age Group


Network-Level Total 701 1,279 228 188 224 91 19 2,730 Median Age 74 74 70 72 72 72 73 73

Gender Female 317 525 103 74 90 40 3 1,152 Male 384 754 125 114 134 51 16 1,578

Network-Level Total 701 1,279 228 188 224 91 19 2,730

Ethnicity* Hispanic or Latino 59 95 1 2 17 1 1 176 Not Hispanic or Latino 642 1184 227 186 207 90 18 2,554


Race* American Indian/Alaska Native 1 1 2 0 1 2 0 7 Asian 12 38 0 1 3 0 0 54 Black or African American 144 130 7 8 17 1 3 310

45



Native Hawaiian or Other Pacific Islander 1 4 0 0 2 0 0 7 White 542 1,105 219 179 201 88 16 2,350 More Than One Race Reported 1 1 0 0 0 0 0 2



Diabetes 316 569 115 88 87 37 9 1,221 Glomerulonephritis 48 84 17 11 19 2 2 183 Secondary Glomerulonephritis/ Vasculitis 17 26 3 4 5 3 1 59 Interstitial Nephritis/ Pyelonephritis 23 54 6 7 10 4 1 105 Transplant Complications 0 0 0 0 0 1 0 1 Hypertension/Large Vessel Disease 167 313 50 40 45 23 4 642 Cystic/Hereditary/ Congenital/Other Diseases 18 28 6 5 8 5 0 70 Neoplasms/Tumors 31 71 11 9 12 7 1 142 Disorders of Mineral Metabolism 0 0 1 0 0 0 0 1 Genitourinary System 1 0 0 0 0 0 0 1 Acute Kidney Failure 0 0 0 0 0 0 0 0 Miscellaneous Conditions 75 123 17 20 37 9 1 282 Not Specified 5 11 2 4 1 0 0 23


Primary Cause of Death**

Cardiac 231 475 61 58 86 33 8 952 Endocrine 0 0 0 0 0 0 0 0 Gastrointestinal 4 13 1 2 1 0 0 21 Infection 98 143 20 13 17 8 0 299 Liver Disease 4 10 3 1 2 0 0 20 Metabolic 2 4 0 2 0 1 0 9 Vascular 36 57 7 9 9 5 1 124

46



Other 225 373 98 74 90 27 5 892 Unknown 80 150 31 16 13 15 2 307 Not Specified 21 54 7 13 6 2 3 106

Network-Level Total 701 1,279 228 188 224 91 19 2,730 Source of data: CROWNWeb *Categories are from the CMS-2728 form. **Categories are from the CMS-2746 form. NOTES: 1. This table may include data on some patients who received dialysis services from U.S. Department of Veterans Affairs (VA) facilities. 2. Data on “ethnicity” and “race” should be interpreted with caution because of the inherent instability of race/ethnicity data.

47

Table 8A. Vocational Rehabilitation Status, Employment Status, and School Attendance of Prevalent Dialysis Patients Age 18–54 Years by Facility in Network 1’s Service Area (as of December 31, 2015)

Facility CCN Aged

18 through 54

Referred to Voc Rehab

Services

Receiving Voc Rehab

Services

Employed Full-Time or Part-Time

Attending School Full-

Time or Part-Time

Connecticut

070025 61 0 0 8 0 070035 18 0 0 4 0 07003F 2 0 0 0 0 072501 101 1 0 16 0 072503 19 0 0 7 0 072504 34 0 0 12 0 072505 12 0 0 4 0 072506 9 0 0 3 0 072507 64 0 1 5 1 072508 18 0 0 2 0 072509 25 0 0 5 0 072510 14 1 0 4 0 072511 58 1 0 8 0 072512 59 0 0 14 0 072514 23 0 0 5 0 072515 31 0 0 11 0 072516 38 5 4 12 1 072517 14 0 0 0 0 072518 18 0 0 4 0 072519 30 0 0 7 0 072520 29 0 1 10 0 072521 34 0 0 9 0 072522 7 0 0 1 0 072523 19 0 1 8 1 072524 17 0 0 7 0 072527 14 0 0 1 0 072528 21 0 1 6 1 072529 23 0 1 8 0 072530 11 0 0 3 0 072531 16 0 0 2 0 072532 5 0 0 0 0 072533 25 0 0 8 1 072534 8 0 0 0 0

48

Facility CCN Aged

18 through 54


Services

Receiving Voc Rehab

Services



Time or Part-Time

072535 19 0 0 5 0 072536 16 0 0 5 1 072537 16 0 0 7 1 072538 20 0 0 2 0 072539 31 0 0 12 0 072540 16 0 0 3 0 072541 11 0 0 4 0 072542 14 0 0 2 0 072543 22 1 0 2 0 072544 23 0 0 10 0 072545 7 1 1 0 1 072546 1 0 0 0 0 072547 2 0 0 1 0 072548 2 0 1 1 0

CT Total 1,077 10 11 248 8

Massachusetts

220028 16 0 0 3 1 220036 19 0 0 5 0 220046 25 0 0 8 0 220071 8 0 0 2 0 220081 1 0 0 1 0 220110 2 0 0 0 0 220123 1 0 0 0 0 221302 1 0 0 1 0 222500 32 0 1 2 0 222501 11 0 0 4 0 222502 36 0 0 0 0 222503 29 0 0 6 0 222504 22 1 0 7 0 222505 19 2 0 2 0 222506 18 0 0 5 0 222507 38 0 0 5 0 222508 30 1 1 7 1 222511 16 0 0 3 0 222512 30 0 0 5 0 222513 20 0 0 2 1 222515 19 0 0 2 0

49

Facility CCN Aged

18 through 54


Services

Receiving Voc Rehab

Services



Time or Part-Time

222516 32 1 1 6 1 222517 27 0 0 6 0 222519 14 1 0 3 0 222520 8 0 0 4 0 222521 43 0 1 7 0 222523 30 1 1 8 1 222524 14 0 0 1 0 222525 31 0 0 1 0 222526 100 0 0 8 1 222529 56 3 0 16 0 222530 30 0 1 2 1 222533 9 0 0 4 0 222534 10 0 0 3 0 222535 17 0 1 1 1 222536 34 1 0 7 0 222537 7 0 0 1 0 222538 50 1 0 9 2 222539 18 0 0 5 0 222542 27 0 0 8 0 222543 22 0 0 3 0 222545 22 0 0 5 0 222546 16 0 0 5 0 222548 1 0 0 0 0 222549 34 2 1 11 0 222550 18 0 0 4 0 222551 19 0 0 3 0 222552 46 0 0 12 0 222553 10 0 0 2 0 222556 13 0 0 4 0 222557 7 0 0 1 0 222559 4 0 0 1 0 222560 13 2 0 0 0 222561 17 1 0 3 1 222562 10 0 0 3 0 222564 50 2 0 14 3 222565 42 1 0 7 0 222567 8 0 0 4 0

50

Facility CCN Aged

18 through 54


Services

Receiving Voc Rehab

Services



Time or Part-Time

222568 6 0 0 1 0 222570 17 1 0 6 0 222571 26 3 1 4 1 222572 7 0 0 1 0 222573 34 4 0 7 0 222574 24 0 1 10 1 222576 17 0 0 3 0 222577 6 0 0 3 0 222578 2 0 0 0 0 222579 13 0 0 4 0 222580 7 0 0 2 0 222581 8 0 0 1 0 222582 24 1 1 3 1 222583 41 0 0 11 0 222584 9 0 0 2 0 222585 5 0 0 4 0 223302 8 1 1 0 1 223504 2 0 0 1 0

MA Total 1,558 30 12 315 18

Maine

200018 9 1 0 0 0 20003F 3 0 0 0 0 202500 25 0 2 8 1 202501 17 0 0 1 0 202502 9 0 0 4 0 202503 15 0 0 2 0 202504 20 0 0 5 0 202505 15 0 0 7 1 202506 18 0 0 2 0 202507 5 0 0 0 0 202508 6 0 0 1 0 202509 7 0 0 1 0 202510 5 0 0 1 0 202511 5 0 0 2 0 202512 35 0 0 4 0 202513 10 0 0 0 0 202514 10 0 0 3 0

51

Facility CCN Aged

18 through 54


Services

Receiving Voc Rehab

Services



Time or Part-Time

202515 12 0 0 2 0 ME Total 226 1 2 43 2

New Hampshire

302500 18 0 0 1 0 302501 20 0 0 4 0 302502 28 0 0 7 0 302503 16 1 0 3 0 302504 11 0 0 4 0 302505 17 0 2 4 1 302506 5 0 0 0 0 302507 31 0 0 8 0 302508 6 0 0 1 0 302509 25 0 0 5 0 302510 7 0 0 1 0 302511 7 0 0 4 0 302512 3 0 0 0 0 302513 7 0 0 2 0 302514 13 0 0 1 0 302515 5 0 0 0 0 302516 6 0 0 1 0 302517 2 0 0 0 0

NH Total 227 1 2 46 1

Rhode Island

41002F 3 0 0 1 0 412501 38 0 1 11 0 412502 9 0 1 2 0 412503 15 0 1 0 1 412504 16 0 0 4 1 412505 27 1 0 3 0 412506 19 0 0 2 0 412507 6 0 1 0 0 412508 10 0 0 2 0 412509 13 0 0 3 0 412510 20 3 0 1 0 412511 20 0 0 4 0 412512 16 0 0 2 0 412514 8 0 0 5 0

52

Facility CCN Aged

18 through 54


Services

Receiving Voc Rehab

Services



Time or Part-Time

413500 50 2 0 9 1 413501 10 0 0 1 0

RI Total 280 6 4 50 3

Vermont

470003 2 0 0 0 0 472500 6 0 0 1 0 472501 6 0 0 0 0 473500 4 0 0 1 0 473501 6 0 0 1 0 473502 11 0 0 1 0 473503 19 0 0 5 0

473504 5 0 0 0 0 VT Total 59 0 0 9 0

Network Total 3,427 48 31 711 32 Source of data: CROWNWeb Voc Rehab = Vocational Rehabilitation

53

Table 8B. Vocational Rehabilitation Status, Employment Status, and School Attendance of Prevalent Dialysis Patients Age 18-54 Years in Network 1's Service Area (as of December 31, 2015)

Category

Referred to

Voc Rehab

Services

Receiving Voc

Rehab Services

Completed Voc

Rehab Services

Not Eligible for Voc Rehab

Services

Declined Voc

Rehab Services

No Voc Rehab Status

Employed Full-Time

Attending School Full-Time 0 0 0 0 0 0 Attending School Part-Time 0 2 0 0 0 0 Not Attending School 0 0 0 17 50 23 School Status Not Specified 1 0 0 3 5 421

Employed Part-Time


Employment Status Not Specified


Homemaker


Retired*


Medical Leave of Absence


54

Category

Referred to

Voc Rehab

Services

Receiving Voc

Rehab Services

Completed Voc

Rehab Services

Not Eligible for Voc Rehab

Services

Declined Voc

Rehab Services

No Voc Rehab Status

Other**


Source of data: CROWNWeb *Retired due to preference or disability **Other = Employment Status of Student or Unemployed Voc Rehab = Vocational Rehabilitation

55

Table 9A. Incident ESRD Patients in Network 1's Service Area, by Ethnicity and Race (January 1, 2015 - December 31, 2015)

Ethnicity* Category Race* Category Number Percent

Hispanic or Latino

American Indian/Alaska Native 0 0.0% Asian 1 0.3% Black or African American 20 5.8% Native Hawaiian or Other Pacific Islander 0 0.0% White 318 93.0% More Than One Race Reported 3 0.9% Total 342 100.0%

Not Hispanic or Latino

American Indian/Alaska Native 4 0.1% Asian 112 3.1% Black or African American 564 15.5% Native Hawaiian or Other Pacific Islander 13 0.4% White 2,937 80.8% More Than One Race Reported 6 0.2% Total 3,636 100.0%

Ethnicity Not Specified American Indian/Alaska Native 0 0.0% Asian 0 0.0% Black or African American 0 0.0% Native Hawaiian or Other Pacific Islander 0 0.0% White 0 0.0% More Than One Race Reported 0 0.0% Not Specified 17 100.0% Total 17 100.0% Total Incident ESRD Patients 3,995 100.0%

Source of data: CROWNWeb *Categories are from the CMS-2728 form. NOTES: 1. This table includes data on dialysis and transplant patients whose initial "Admit Date" in CROWNWeb was within the calendar year. Excludes patients with a "Discharge Reason" of acute kidney failure. 2. This table may include data on some patients receiving dialysis services from U.S. Department of Veterans Affairs (VA) facilities. 3. Data on "ethnicity" and "race" should be interpreted with caution because of the inherent instability of race/ethnicity data.

56

Table 9B. Prevalent ESRD Patients in Network 1's Service Area, by Ethnicity and Race (January 1, 2015 - December 31, 2015)

Ethnicity* Category Race* Category Number Percent

Hispanic or Latino American Indian/Alaska Native 2 0.1% Asian 2 0.1% Black or African American 77 5.0% Native Hawaiian or Other Pacific Islander 6 0.4% White 1,456 93.7% More Than One Race Reported 11 0.7% Total 1,554 100.0%

Not Hispanic or Latino American Indian/Alaska Native 23 0.2% Asian 438 3.5% Black or African American 2,953 23.9% Native Hawaiian or Other Pacific Islander 53 0.4% White 8,875 71.8% More Than One Race Reported 23 0.2% Total 12,365 100.0%

Ethnicity Not Specified

American Indian/Alaska Native 0 0.0% Asian 0 0.0% Black or African American 0 0.0% Native Hawaiian or Other Pacific Islander 0 0.0% White 1 25.0% More Than One Race Reported 0 0.0% Not Specified 3 75.0% Total 4 100.0% Total Prevalent ESRD Patients 13,923 100.0%

Source of data: CROWNWeb *Categories are from the CMS-2728 form. NOTES: 1. This table includes data on all patients identified in CROWNWeb as alive and receiving dialysis services as of December 31, 2015. 2. This table may include data on some patients receiving dialysis services from U.S. Department of Veterans Affairs (VA) facilities. 3. Data on "ethnicity" and "race" should be interpreted with caution because of the inherent instability of race/ethnicity data.

57

Table 9C. Renal Transplant Recipients* in Network 1's Service Area, by Ethnicity and Race (January 1, 2015 - December 31, 2015)

Ethnicity** Category Race** Category Number Percent

Hispanic or Latino American Indian/Alaska Native 0 0.0% Asian 2 2.2% Black or African American 6 6.6% Native Hawaiian or Other Pacific Islander 0 0.0% White 83 91.2% More Than One Race Reported 0 0.0% Total 91 100.0%

Not Hispanic or Latino American Indian/Alaska Native 0 0.0% Asian 31 4.8% Black or African American 108 16.8% Native Hawaiian or Other Pacific Islander 4 0.6% White 497 77.4% More Than One Race Reported 2 0.3% Total 642 100.0%

Ethnicity Not Specified American Indian/Alaska Native 0 0.0% Asian 0 0.0% Black or African American 0 0.0% Native Hawaiian or Other Pacific Islander 0 0.0% White 1 4.8% More Than One Race Reported 0 0.0% Not Specified 20 95.2% Total 21 100.0% Total Transplant ESRD Patients 754 100.0%

Source of data: CROWNWeb *Data are shown for unduplicated patients. A patient who had more than one transplant during the calendar year is counted only once in the table. **Categories are from the CMS-2728 form. NOTE: Data on "ethnicity" and "race" should be interpreted with caution because of the inherent instability of race/ethnicity data.

2015 Annual Report - IPRO...The End Stage Renal Disease Network Organization Program (ESRD Network...

Documents

Transcript of 2015 Annual Report - IPRO...The End Stage Renal Disease Network Organization Program (ESRD Network...