I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Bill Peckham on December 23, 2010, 09:28:15 AM
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Pro Publica has released the Dialysis Facility Reports for every dialysis unit in the country from 2002 to 2010. There is a lot of information available through a snappy data base interface.
Check out the article http://www.propublica.org/article/dialysis-data-once-confidential-shines-light-on-clinic-disparities (http://www.propublica.org/article/dialysis-data-once-confidential-shines-light-on-clinic-disparities)
And then check out your unit: http://projects.propublica.org/dialysis/ (http://projects.propublica.org/dialysis/)
Post questions, comments and findings.
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When I entered my zip code the data base brought up the four units closest to my house and presented summary information from the reports. You can then click on one of the units to view its page. At the bottom of the unit page you'll see the years 2002 - 2010 (if the unit has been open the whole time) and that is where you can view the actual DFR.
Looking at the actual DFR is interesting because it gives a lot more detailed data. One thing it does is give the unit's performance in the context of state performance. I would be interested in seeing state performance, state by state.
If you are checking out the 2010 DFR for your unit post the state and network averages for standard mortality rate (line 1j of the DFR), percent of hospitalizations due to infection (line 2m, a percent of 2e), total hospitalization days (line 2e), standard transplant rate (line 3k) and percent of patients on the transplant waitlist (line 4b). I'll update this post so we have a complete list in one place.
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STATE (3k)STR (4b)Patients on the waitlist
Nation(5,413) 1.00 24.2
AL(121) .7 33.9
AK( 8 ) 1.03 25.5
AZ (103) 1.19 21.7
AR ( 64) 0.87 9.9
CA(484) 1.00 36.5
FL(326) 1.01 17.0
IL(219) 1.22 27.0
NJ(23) 1.30 30.9
WA(69) 1.3 22.8
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STATE (1j)SMR (2m)Septicemia(%) (2e)Days hospitalized per PY
Nation 1.00 12.0 14.5
AL 1.08 10.5 13.1
AK 1.03 6.9 9.59
AZ .98 12.4 13.7
AR 1.14 13.7 16.4
CA 1.00 11.5 12.3
FL 1.12 14.3 16.5
IL 1.00 13.6 14.5
NJ .98 14.7 17.3
WA .93 9.7 9.32
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NETWORK (3k)STR (4b)Patients on the waitlist
3 (NJ,PR,VI) 1.10 23.3
7 (FL) 1.01 17.0
8 (AL,MS,TN) 0.77 23.9
10 (IL) 1.22 27.0
13 (AR) 0.76 27.0
15 (AZ) 1.20 22.0
16 (WA,OR,ID,MT,AK) 1.32 19.6
17 (N CA) 0.98 47.8
18 (S CA) 0.94 27.1
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NETWORK (1j)SMR (2m)Septicemia(%) (2e)Days hospitalized per PY
3 (NJ,PR,VI) 1.10 15.0 16.7
7 (FL) 1.12 14.3 16.5
8 (AL,MS,TN) 1.03 11.6 13.4
10 (IL) 1.00 13.6 14.5
13 (AR) 1.13 13.6 16.2
15 (AZ) .95 14.7 16.5
16 (WA,OR,ID,MT,AK) .95 8.7 9.1
17 (N CA) .98 9.3 10.7
18 (S CA) 1.01 12.4 13.0
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Jenna's ex-dialysis center looks pretty good. The disturbing bit of info: Date of Last Inspection April 11, 2002
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Bill, I found Jennas clinic but I don't see the line numbers you refer to? http://projects.propublica.org/dialysis/facilities/52619
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Bill, like Okarol, I am not sure I found the state stats you were asking about, but I found the particulars on my clinic.
http://projects.propublica.org/dialysis/facilities/142614
Does this help?
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You have to go to the actual PDF for 2010. At the bottom of the page you link to MM there is a row of years. Click on 2010 to see a DFR in its entirety - a lot of details. You'll see each row of data is labeled with a number and letter. 18 pages of actual numbers. When do we ever get actual numbers?!
Very interesting stuff.
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I think my brain has exploded...
I skimmed the whole 18 pages and then printed them out. It's nice to have a lot of numbers, but you need to be careful in how you interpret them. I guess the best thing to do is to look at the types of patients that receive D at the unit and see where you might fit in. The vast majority of patients at my clinic are diabetic, hypertensive or have some other cardiovascular difficulty, so the numbers are going to reflect that, I suppose. I have none of those co-morbidities, so I am not sure where I fit in. I do see that there are only 3 other patients doing home hemo; I wish there was some way to find out if these patients were doing NxStage or home nocturnal.
On the very last page, Table 12: Survey and Certification Activity...well, that's where I get a bit confused. The report states "12.c Compliance condition after last survey..."Does not meet requirements". What does that mean? And 12e CfC deficiencies cited at last survey...V110 Governing body and management..."Yes, cited:...what exactly was cited? Does this mean that the Governing Body and management of this clinic is not very good?
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I think my brain has exploded...
I skimmed the whole 18 pages and then printed them out. It's nice to have a lot of numbers, but you need to be careful in how you interpret them. I guess the best thing to do is to look at the types of patients that receive D at the unit and see where you might fit in. The vast majority of patients at my clinic are diabetic, hypertensive or have some other cardiovascular difficulty, so the numbers are going to reflect that, I suppose. I have none of those co-morbidities, so I am not sure where I fit in. I do see that there are only 3 other patients doing home hemo; I wish there was some way to find out if these patients were doing NxStage or home nocturnal.
On the very last page, Table 12: Survey and Certification Activity...well, that's where I get a bit confused. The report states "12.c Compliance condition after last survey..."Does not meet requirements". What does that mean? And 12e CfC deficiencies cited at last survey...V110 Governing body and management..."Yes, cited:...what exactly was cited? Does this mean that the Governing Body and management of this clinic is not very good?
I think you're right we will have to learn how to read the numbers. That's one reason I wanted to get a list of states going because I think a unit's performance should be seen within the context of their state and network.
The Vtags reference specific Conditions for Coverage, surveyors use the CfCs as their guide when they survey. (more info on CfCs (http://www.esrdnetwork18.org/professionals/Condition_for_Coverage/CondForCov.php))
There are a lot of parts to the CfC. One has to do with the unit governance - for instance there has to be people identified as responsible for operations as spelled out in written policies and procedures. In fact the policies and procedures have to be reviewed and signed off on by the corporate governance body. As a NKC trustee I reviewed NKC P&Ps, as chair I had to sign off on them.
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Thanks for that, Bill.
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Facility Fresenius Englewood NJ
1J SMR 2M 3K 4B
.93 15.6 1.87 31.3
State NJ
.98 14.7 1.30 30.9
Network Fresenius
1.10 15.0 1.10 25.3
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Thanks Carol. I added NJ, IL and CA, and I broke the info into Tx and Dx
I think the state/network averages underscore that people using dialysis are largely hospitalized with septicemia - which can be minimized through strict adherence to best practices.
It also shows that medical practices and outcomes vary from region to region. Your zip code matters!
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I am astonished at how many people have looked at this so quickly. I too, need time, to look at it and take it all in.
I can only tell you that in the clinic in Florida where I felt sick after each session the dialysis adequacy was 78%!!!!!!!!!!! In the clinic in Enfield, Ct which I loved the dialysis adequacy was 98%. Maybe that explains why I felt good coming out of the Enfield one and lousy out of the Florida one.
I found the septicemia level way high.
Carol, I can't believe the unit your daughter was in was not inspected since 2002 - There ought to be a law!
Bill's work will take some time to look over but he has done remarkable work already.
Moose's Mom did you click on the compare to four nearest to compare them. You center looks good on here. (ps did you son make it without any trouble?)
Good Start - we need all the info we can get....
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billmoria, yes, I did have a look at the other four nearest centers. Actually, I had looked at this info some months ago but had not seen it in its entirety, ie in PDF form, which gives much more detailed information about what all of those funny figures actually mean.
I agree with the septicemia concerns. That's how my mom died...sepsis due to a UTI...at least that's what I was told and that's what her chart said. I am not aware of infection in her access (av fistula), but septicemia in any dialysis patient raises a red flag in my mind.
I was pleased to see that the majority of patients in my clinic have an AV fistula but but was disappointed to see that a staggering number didn't when they first began dialysis.
I was glad to see that 100% were informed that transplantation was an option.
I was not glad to see that the average GFR prior to D was 14.2 in 2009. I think that's a bit high and is in fact higher than the state/network/national average. Mine is a small clinic not managed by one of the big providers, so maybe my neph is a bit conservative in this regard. I'm certainly not going to go by gfr alone.
And yes, my son made it in from London; he was rebooked and the airlines upgraded him to first class! Thanks for asking.
Bill, I am a bit confused about table 8, namely the distinction between 8h "Average duration of ESRD (years)" and 8i "Years since start of ESRD." Can you shed some light? Thanks.
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My old centers were both equal or above the state averages for survival and usually lower on the mortality numbers - but they were affiliated non-profits so I'm not really surprised. I knew I was getting good treatment compared to the horror stories I heard from others on here.
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Bill, I am a bit confused about table 8, namely the distinction between 8h "Average duration of ESRD (years)" and 8i "Years since start of ESRD." Can you shed some light? Thanks.
Sections 8 gives a snapshot of the unit
On 12/31 there were x number of patients being treated by the unit (8a)
8h says that the average length of time using dialysis among this group
8i breaks it down by periods of time - giving percentages of each group.
It's two ways to describe the vintage of the patient population. 8h is summarizing; 8i gives more detail. Maybe you'd see two units both with 8h=5 but under 8i one unit might have more long term dialyzors. I could theorize that all else being equal I would take the unit with more long term dialyzors but it might mean that for some reason they have a high first year mortality too.
I think the way to use this info when shopping units is to use it to inform your questions. For instance if I saw a unit with a lot of long term dialyzors and a high first year mortality that would be something I would ask about. The unit may be serving two patient populations under one clinic id number - the Seattle Kidney Center (http://nwkidney.org/nkc/aboutUs/locations/seattle.html) has three treatment floors under one id number. There is a standard community center with 20 or so stations on the third floor and a Special Care Unit (PDF (http://www.nwkidney.org/aboutUs/news/newsletters/OUTPUT_Mar_Apr_2009.pdf)) with 15 beds on the second floor. On the forth floor there is NKC's large home programs (http://nwkidney.org/nkc/dialysis/homeDialysis/index.html) that is following about 250 people at home on PD and HD. I haven't looked through the SKC DFR today but it has always been an outlier in how the numbers correlate.
This paperwork detail - all NKC home patients appear on the SKC DFR - also means that NKC's other community centers all look like they have no home dialysis when several are the site of clinic visits.
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KABOOM!
(That was my head exploding.)
OK, let me ask you this. With this report in hand, and knowing that I am younger than the average dialyzor at my unit AND knowing that I have no comorbidities (whereas the average number of comorbidities in my unit is 5), to which bits of this report should I pay most attention?
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I am disturbed that my centers septicemia # is the highest up there so far.... What does that mean..... what should I do about it?
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This is a really important and informative thread. What would you mods think about making it a "sticky"?
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I am disturbed that my centers septicemia # is the highest up there so far.... What does that mean..... what should I do about it?
I think the variation between states is significant but I don't have a ready answer as to why there is variation. The thing about septicemia is that it is almost entirely preventable. In FL 1 out of 7 hospital days are due to septicemia or 2 days a year.
Why would it vary from state to state? We could guess but it isn't clear.
Then you need to look at your unit and how it compares to others in the state. The thing I think about is that I have been on dialysis for over 20 years - I have never had septicemia. In the entire time I have been on dialysis I have never had a dialysis related hospitalization except for the parathyroidectomy and a renal cancer, neither directly related to a treatment.
Dialysis should not result in hospitalization. I think there is a lot individuals can do to protect themselves. To start with wash your arm and hands when you arrive at the unit. Be theatrical about it and set an example. And then ideally do what I did and cannulate yourself incenter. Take responsibility for your cannulation and make sure you do a good job. Support staff efforts around hand washing and encourage other patients to wash their own arm and hands. But the main thing is that the point where the needle enters the arm has to be clean, you the patient can take responsibility for that.
I haven't looked but one leading cause of septicemia is catheter use, so one way to protect yourself is to have a fistula or a graft instead.
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Bill, that's just the sort of info I like...not merely what the risks are but, rather, what we as patients can do to minimize those risks.
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KABOOM!
(That was my head exploding.)
OK, let me ask you this. With this report in hand, and knowing that I am younger than the average dialyzor at my unit AND knowing that I have no comorbidities (whereas the average number of comorbidities in my unit is 5), to which bits of this report should I pay most attention?
I'm not sure MM. To me the difference in dialysis unit to unit correlates most closely to staff and their experience. Even with all this information I would want to have a sense for what it is like to work at the unit. What is the staff turnover?
That said it can be fun to dialyze at a unit where everyone knows your name, and the staff have been there forever but that doesn't mean it is safe. There, just like everywhere else, the safest thing to do is take ownership of your health and I would need to be at a unit that encourages, supports, celebrates patients that own their health. One question that tells me just about all I need to know - do some patients (veteran, engaged patients) at the unit determine their own target fluid removal?
As far as these DFRs and what I am getting out of them ... I've always been struck by the numbers. The actual numbers. That's how many people went through the unit, how many individuals left via Tx or death. The hospitalization - how many in that unit, among those people, where hospitalized. How many hospitalizations could have been avoid if every other day dialysis was an option? To me looking at the DFRs is seeing the unit in context. I see the in flow and out flow of patients and I think of the staff living these numbers with us. We normally get to know one sixth the unit this is an accounting of the whole thing. It's a different view, it's the view the staff know.
MM I think the report should tell you that you are entering a world that is mostly not about you. You won't be special in a room full of dialyzors. You need to care the most about you. Everyone else is busy.
Edited to add: That's a little strong but the numbers are astounding. You're entering a relationship with a unit and I think this lets you know a little more about who you're partnering up with, think of it like a relationship. It use to be only the unit that knew, or thought they knew, everything about you; you knew their phone number. Now you know a little about them. It's not that any one piece of information is actionable but it should inform you. This evens the playing field a bit.
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Even playing fields are nice...
Thanks for that. I agree with the view that I am not special and that everyone else is busy, that this is a world mostly not about me. It's a sentiment that I have lived by for years, and it will serve me well once I start D, too, so thanks for the reminder. :thumbup;
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There is a cool feature where you can rank all units in a state by all sorts of criteria.
Go to the front page http://projects.propublica.org/dialysis/ (http://projects.propublica.org/dialysis/)
Select from the state list. You should get to a page that shows a map with the units represented by dots; underneath the map a scrollable list of all the dialysis units in the state. I selected California so it's a list of over three hundred units.
Between the map and the list there is a box "SELECT FACILITY CRITERIA THAT MATTER TO ME". Click that box.
Now when you check one or more of the boxes on the fly out menu, those categories are now displayed as part of the unit list. You can click on the column heading to sort the list.
Very cool.
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Oooh, that IS cool!
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Bill, great posts as always. This tool if used by dialysis patients has the potential to truly change dialysis in America. The wider it is published and the more people it reaches the better. Wait till the widgets in the dialysis widget factory start questing Willy Wonka on why the chocolate factory isn't working right. Perhaps we can actually regain our autonomy and patient choice as dialyzors. It is a welcome addition.
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MM, I think it lets you draw some inferences. If the number of patients with controlled anemia is close to 100%, then there's a good chance that the place is doing more than shuffling the patients in and out the door as fast as they can without caring about quality of life, because they are working to deal with side effects. The adequate dialysis category is good for that, too. If the number of patients on the transplant list and the number of transplants is high, they are doing what they can to encourage that option. Good numbers aren't a guarantee of a good, caring staff, but they sure raise the odds.
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Jbeany, yes, you're right. I have been paying particular attention to those numbers, along with the numbers indicating how many patients do home hemo (only 4 out of 80 some-odd at my clinic) as this is how I plan to proceed.
How can we make sure all of our IHD members see this thread and the propublica link? I know the moderators have a way of "stickying" important threads, right? I just think this is really important..giving people as much information as possible.
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Jbeany, yes, you're right. I have been paying particular attention to those numbers, along with the numbers indicating how many patients do home hemo (only 4 out of 80 some-odd at my clinic) as this is how I plan to proceed.
How can we make sure all of our IHD members see this thread and the propublica link? I know the moderators have a way of "stickying" important threads, right? I just think this is really important..giving people as much information as possible.
I think this data base will be a part of the dialysis world from here on so whether it is at the top or not (it probably should be) won't take away from being able to direct people here and explain how it can be used. I think the Pro Publica data base is open source so it shouldn't be long before we see sites remixing it or combining it with dialysis facility compare data, for instance on facilities offering shifts starting after 5 or Home Dialysis Central's data. Put all three together would be very interesting.
This internet thingy is pretty cool, I think it is going to catch on.
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http://projects.propublica.org/dialysis/categories (http://projects.propublica.org/dialysis/categories#new_death_rate)
There is another cool feature. Click the above link to read the summary description of each statistical category. Then click the "show me details" button to see the Guide to the 2010 Dialysis Facility Reports, which goes through the DFR line by line.
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How can we make sure all of our IHD members see this thread and the propublica link? I know the moderators have a way of "stickying" important threads, right? I just think this is really important..giving people as much information as possible.
I did put it on the front page of the DialysisEthics website, but it gets pretty lonely there: http://www.dialysisethics2.org/
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:thumbup; Topic stickied!
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:thumbup; Topic stickied!
:thx;
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Great! I think a lot of IHD members will find the link very useful, but over the holidays, it could easily be missed by members who haven't had the time to visit IHD for a while.
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Thank you bill! I do wash but do not self cannulate I am scheduled for transplant...but know that in the future I will try to do more for myself when /if I get back on,dialysis
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Very good information, thank you for sharing. I found there were several other centers within 30 minutes of mine, if I ever decided to switch.
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I want to thank you so much for posting this linik. The information about my clinic (especially the mortality rates) is fascinating material. I'm going to be going through some of the major points and posting them on my blog later this week.
Thanks again.
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Hello All; I am wondering, as a patient safety advocate if anyone has seen a change in the delivery of care in their unit since the media exposure of care. In California, we have finished posting the surveys for 2010 so that if you are in California, you can see if your facility has been inspected, as well as seeing what deficiencies were cited. In the first six months of 2010,, 23 of 25 facilities had deficiencies cited for lack of implementing correct infection control practices. This is UNACCEPTABLE when the most basic of basic practices are not implemented. Yes, we are talking about the facility's own policies and procedures, as well as federal level regulations.
I am also wondering, but had trouble starting a new thread --- have any of you experienced bullying from staff, retaliation from staff, etc... and, if so, why? This seems to be a more recognized problem now by the feds
www.qualitysafepatientcare.com
Roberta Mikles
Dialysis Patient Safety Advocate
uncompensated with NO ties/connections to the industry
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I am wondering if there is anywhere where you can find the financial information for dialysis units. Costs, earnings, profits, and whatnot.
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I am wondering if there is anywhere where you can find the financial information for dialysis units. Costs, earnings, profits, and whatnot.
If the provider is a public company they have to file quarterly/annual reports to the SEC, for instance DaVita's are here http://investing.businessweek.com/research/stocks/financials/secfilings.asp?ticker=DVA:US (http://investing.businessweek.com/research/stocks/financials/secfilings.asp?ticker=DVA:US)
look for the links to the 10-K Annual report released in February or the 10-Q quarterly reports.
Lots of fine print but lots of information too.
If your interested in a non-profit company then you can pull their 1090 via Guidestar.
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I am not really sure what the unit is at the moment. It was an FMC unit until I think some point last year, at which case it became an independent company. It is definitely for profit, though..of that there is NO mistake!
"Sooner Dialysis, where we say 'keep the change'...and we do!"
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Thanks for the link...the staff at my unit are fabulous and it was comforting to see the numbers are pretty darn good as well!
http://projects.propublica.org/dialysis/facilities/202502
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Not really sure how I feel about this data. o.0
http://projects.propublica.org/dialysis/facilities/182592 (http://projects.propublica.org/dialysis/facilities/182592)
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Not really sure how I feel about this data. o.0
http://projects.propublica.org/dialysis/facilities/182592 (http://projects.propublica.org/dialysis/facilities/182592)
I'd be real interested to hear more - over the years of advocating for this information I heard a lot said about downsides to the information's release ... now that it is out I'd like to hear more about how it is seen. I'd really like to hear about concerns or downsides that are seen.
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Not really sure how I feel about this data. o.0
http://projects.propublica.org/dialysis/facilities/182592 (http://projects.propublica.org/dialysis/facilities/182592)
WOW...86% of patients at your center were NOT seen by a nephrologist before beginning dialysis? That's outrageous! Why do you think that is?
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What does that mean, exactly? They weren't followed by any neph? They weren't followed by the center's neph? It seems unlikely that 86% of patients at any center would be acute onset.
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What does that mean, exactly? They weren't followed by any neph? They weren't followed by the center's neph? It seems unlikely that 86% of patients at any center would be acute onset.
There is a question on a form that is filled out on the day of your first treatment ... check it out
https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf (https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf)
Think about it: Was patient under care of a nephrologist? Yes or No. 86% of the time it was no. Wow. I was under a nephrologist's care for about 33 months prior to starting ESRD therapy.
EDITED TO ADD: In the business these are called the 2728s, pronounced: the twenty-seven twenty-eights.
You can ask to see your own 2728 ... make sure it is correct.
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Geez, I've been seeing my neph for almost 7 years now!
jbeany, I'm assuming that 86% of new dialyzors at this particular clinic had CKD but never knew it, so never saw a nephrologist because they didn't think they needed to. These are probably people who don't have regular checkups in the first place. But that just seems outrageous.
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I would question this nephrologist number simply because the facility has a good fistula rate: Fistula Percent of patients with a fistula, 2009: 67%
Even IF the fistula rate were counted within the first 90 days of treatment, that is a GREAT rate compared to the 58.6% national average (5/2011)*, and I think that a nephrologist would at least be informed by the vascular surgeon who placed the fistula.
I would look for clerical error in the case of this clinic.
*http://fistulafirst.org/
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Or maybe an ESL thing - perhaps a large percentage who didn't know what a neph was?
There is a question on a form that is filled out on the day of your first treatment ... check it out
https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf (https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf)
Well, I suppose there was - it was 5 years ago and the center is now 5 hours away! I don't remember them doing more than shoving a stack of papers at me while I was nervous and half scared out of my wits. (Thanks to being on here, I did have enough clarity to refuse to let them put epo through my lines so I could stay in control of it and get my usual injections, though.) Still, if other centers are even less inclined to help patients fill out paperwork, maybe my ESL theory is part of it.
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Or maybe an ESL thing - perhaps a large percentage who didn't know what a neph was?
There is a question on a form that is filled out on the day of your first treatment ... check it out
https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf (https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf)
Well, I suppose there was - it was 5 years ago and the center is now 5 hours away! I don't remember them doing more than shoving a stack of papers at me while I was nervous and half scared out of my wits. (Thanks to being on here, I did have enough clarity to refuse to let them put epo through my lines so I could stay in control of it and get my usual injections, though.) Still, if other centers are even less inclined to help patients fill out paperwork, maybe my ESL theory is part of it.
ESL in Bath Maine (http://bathme.usl.myareaguide.com/demographics.html)? ;) Looks to me the issue is that there is no Nephrologist in Bath Maine (http://www.healthgrades.com/nephrology-directory/me-maine/bath). I don't think I have ever seen this discussed but I think I would move if I lived somewhere without a resident nephrology practice. Even if there was a dialysis center (which Bath obviously has).
The form is filled out by staff and physicians. Payment increases with comorbidities. I've always thought if every dialyzor checked their own 2728 many people would be surprised to learn they had a drinking or drug problem.
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huh, betcha every one of us gets marked down with an anxiety disorder at least - because who isn't anxious starting D?!
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Or maybe an ESL thing - perhaps a large percentage who didn't know what a neph was?
There is a question on a form that is filled out on the day of your first treatment ... check it out
https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf (https://secure.ssa.gov/apps10/poms/images/Other/G-CMS-2728U3-1.pdf)
Well, I suppose there was - it was 5 years ago and the center is now 5 hours away! I don't remember them doing more than shoving a stack of papers at me while I was nervous and half scared out of my wits. (Thanks to being on here, I did have enough clarity to refuse to let them put epo through my lines so I could stay in control of it and get my usual injections, though.) Still, if other centers are even less inclined to help patients fill out paperwork, maybe my ESL theory is part of it.
ESL in Bath Maine (http://bathme.usl.myareaguide.com/demographics.html)? ;) Looks to me the issue is that there is no Nephrologist in Bath Maine (http://www.healthgrades.com/nephrology-directory/me-maine/bath). I don't think I have ever seen this discussed but I think I would move if I lived somewhere without a resident nephrology practice. Even if there was a dialysis center (which Bath obviously has).
The form is filled out by staff and physicians. Payment increases with comorbidities. I've always thought if every dialyzor checked their own 2728 many people would be surprised to learn they had a drinking or drug problem.
I live in Brunswick, Maine, near the Bath border and dialyze at the Bath facility.
There are no lack of nephrologists in this area. Large practices exist in both Portland and Lewiston with Nephs having satellite offices all over the state. Mine is from Lewiston and she has an office in nearby Topsham about 5 miles away. A member of the practice comes to the unit once a week to check up on us.
I was stage 4 ESRF before I knew I had kidney disease and began seeing a nephrologist.
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Oh...lol. This is why it seems odd to me...
Bill, you confused my facility with JBeany's.
Bath's percentage of people who saw a Neph was 40%....her facility is the one in Meadows East, Louisville, Ky. ;)
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Oh...lol. This is why it seems odd to me...
Bill, you confused my facility with JBeany's.
Bath's percentage of people who saw a Neph was 40%....her facility is the one in Meadows East, Louisville, Ky. ;)
Oh, I was totally confused.
It would be interesting to know what was behind the 86% number in Louisville and their fistula number. Actually the DaVita Lousiville DFR would be an interesting DFR to dig into because their indicators seem to be pointing in different directions.
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I continue to receive calls from patients and their loved ones. If you have had a negative outcome as the result of a dialysis technician not implementing the correct practice, you can file a complaint with the state (California) and an investigation will be conducted. For specific incidents, where you might have ended up in the hospital, or had a negative outcome, injury/harm, there can be an investigation. These technicians are now certified and I wonder if they know, just as the RN, that if they are responsible for a negative outcome as the result of a preventable error an investigation can be conducted. These individuals, as RNs and LVN/LPNs, are licensed and technicians are now certified. If they are not certified they are suppose to be working under the supervision of someone who is.......................
Roberta Mikles
www.qualitysafepatientcare.com
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I'm new to this website, and new to dialysis (2 months). I have very real and serious questions/concerns about my center. On the surface, it appears "OK", but upon talking to some patients - I am shocked at their reports, opinions, and experiences.
Don't know what to think, who to speak to, etc.???!!!! Where oh where do I start?
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Cricket -- what are the problems that you are hearing from other patients? Have you experienced similar? Have you observed such?
If you, yourself, are experiencing problems you can ask for a care conference/treatment team/care planning meeting (some units call it different). As a new patient, you should meet with your entire team (nurse, doctor, dietician, social worker) and discuss your individualized treatment plan. You can bring up your concerns at this time. You can also be educated as to what staff wiill do regarding your treatment.
You can also speak with your nephrologist. However, I will give you a head's up as there are nephrologist out there who will not support the patient and support the staff. In fact, when my father was alive, he experienced major retaliation from some staff and the physician never really cared. It was always determined that we were wrong for some reason, never taking into account that there were staff who acted inappropriately .. Can you imagine a technician telling patients and family members that (this tech) needed to take anger management classes? HELLO.. Or staff deliberately ignoring a patient who needed help,... well, there are units where this takes place.. but, there are also good units.
There used to be a great manual for technicians that was available for anyone. A great teaching tool. I think you can still get it.
http://www.kidneyschool.org/
Above opinions of Roberta Mikles
www.qualitysafepatientcare.com
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I'm new to this website, and new to dialysis (2 months). I have very real and serious questions/concerns about my center. On the surface, it appears "OK", but upon talking to some patients - I am shocked at their reports, opinions, and experiences.
Don't know what to think, who to speak to, etc. ??? !!!! Where oh where do I start?
What are your concerns?
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Absolutely,,, please share with us your concerns.
Roberta
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I was reading all these statistics and see that Sempticemia is on the list. Is this a fairly common occurance for dialysis pts? I have had that but I got it when I received a transplant. Almost killed me but I have never heard of anyone getting it while on dialysis. :waiting;
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An updated 'tracker' has been completed by ProPublica -- www.propublica.org/dialysis
This will give you details on your facility -- this is the data that CMS was protecting prior to the original ProPublica article
To View California Inspection Reports --- www.qualitysafepatientcare.com
Having a problem with delivery of care in your unit -- call 1-800-847-8842 Healthcare Dialysis Coalition - NON INDUSTRY CONNECTED - helping patients receive quality, safe care ................
Roberta Mikles BA RN
Dialysis Patient Safety Advocate
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I like my dialysis center. They do a good job, for the most part, but there's this one nurse who's really weird. At the end of four hours on the machine he started taunting and teasing me. As an ex-Infantry soldier I had to restrain myself from clobbering the clown. I did lose my temper, and call him a rear end (well, the other word that starts with an "A"). The rest of the staff is usually very friendly with me, but they've been giving me the cold shoulder. I don't really care, since I'm doing my last hemo treatment today, but I've decided to report him to the head nurse. If it happens again, tonight, I'll write a letter to the appropriate person on the complaint ladder. I wish I could just deck the guy. I hate being an adult sometimes.
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Wow really what was he teasing you about if you don't mind me asking? I would report him anyway because that is neither appropriate nor professional especially in there line of work. I would be damned if some tech was teasing me I would take my needles and stab him right in the neck.
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My dialysis center doesn't stack up too well against others in my area. I don't know if I should change or what...my nephrologist told me that he wanted me to go to another center from the beginning but the one I go to is just a few blocks from my house. Of course, I go to dialysis by medical transport so it really doesn't matter where it is.
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Thanks for posting this Bill. I'm glad SeaTac looks pretty good as do the others I sometimes run back up at. I am lucky to have never had an infection in my access. I'll have to check out the ones I sometimes go to in Spokane later!
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I recommed dialysispatients.org and usrds.org
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No
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huh, betcha every one of us gets marked down with an anxiety disorder at least - because who isn't anxious starting D?!
DSM-V has categorized many aspects of normal life as a "disorder". Your dog died and your depressed? It's actually a "disorder" now. Ditto for worry and anxiety. I suspect i't because diagnosis==$$
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Hi Noahvale,
Thanks for the information although I don't understand what it has to do with anything. If you're interested in getting information on a disease you go to as many places as you can to do your due dilligence. This is another option for doing that. I provide information to dialysis patients at no charge to them, and am happy to include information on diabetes and hypertension and cardiovascular issues that I get free of charge from dialysispatients.org. My dialysis provider was DaVita and I have no issues with them.
JaeCie
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Thanks Noahvale, considering we all have a foot and a half in the grave, it's great to be able to have these conversations and it's totally awesome to have choices. Continued best wishes to you on this journey.