Patients influencing quality of care

[hatedialysis2]

"The Leapfrog Group is a nonprofit watchdog organization that serves as a voice for health care purchasers, using their collective influence to foster positive change in U.S. health care. Leapfrog is the nation’s premier advocate of hospital transparency—collecting, analyzing and disseminating hospital data to inform value-based purchasing."

"Leapfrog Takes Action
In 2007, The Leapfrog Hospital Survey began asking hospitals about their process for handling serious reportable events. A hospital "fully meets standards" if they agree to all of the following if a Never Event occurs within their facility:

We will apologize to the patient and/or family affected by the Never Event
We will report the event to at least one of the following agencies: The Joint Commission, as part of its Sentinel Events policy; state reporting program for medical errors; or a Patient Safety Organization
We agree to perform a root cause analysis, consistent with instructions from the chosen reporting agency
We will waive all costs directly related to a serious reportable adverse event
We will make a copy of our policy available to patients and payers upon request"

http://www.leapfroggroup.org/Influencing

It would be great if they had something similar for dialysis clinics.   I am not sure if the CMS ratings available for clinics provide enough information for patients to choose from or to incentivize clinics to provide top notch service and care.  I was watching the Stossel report and he made a great point about the fact that although hospitals have the advance technologies, customer service is lacking.  From rediculous long waiting to filling out redundant forms.   He goes on to mention that hospitals view the payer (insurance, CMS) as the customer and they aim to please them.   I find that is true in the dialysis world where the clinics are always trying to make sure that my labs looked good regardless of how I felt.  The fact that I had research and diagnose my own symptoms because none of the team of nurses or doctors were able to help me or even hint at why I was suffering from certain ailments that were all dialysis related.  With more transparency and accountability hospitals, clinics would be more incentivised to compete for us to improve quality of care, customer service,  which will drive down costs while promoting smart innovations.   Then I started thinking about the video that was posted on this forum by Okarol about Bill Peckham discussing his amazing and inspiring travels and experience in various clinics around the world.   Foot massages in a dialysis center in France  a socialist country!. Binoculars with views of the Barriar Reef in Australia!    Can you imagine the fast changes that will occur if we the patients had the power in our free economy to force our antiquated dialysis clinics and their delivery systems to compete for our dollars and use it wisely.         

[Simon Dog]

My MD told me Fresenius has a policy of paying for the meds (at about $95K for the treatment) in a patient picks up Hep-C in one of their clinics.  Nationally, the statistics are about 0.34% change per patient year for in-center hemo patients.

[hatedialysis2]

My MD told me Fresenius has a policy of paying for the meds (at about $95K for the treatment) in a patient picks up Hep-C in one of their clinics.  Nationally, the statistics are about 0.34% change per patient year for in-center hemo patients.

Thats good to know.   Do they inform each patient of this fact?  It would be great if such info was posted on a site that compares all the different centers and how compete to provide quality of care with patient reviews.   It would be great to know if there is a certain clinic that has a high infection rates and of what.  And for sure if they offer massages, or other perks.

[kickingandscreaming]

I'm afraid they're too busy maximizing profit from the "bundle" to care much about "customer service" or even the best care.

[Charlie B53]

I go to a DCI, Inc., Clinic in Columbia, MO.  I've only been on PD three years this month and the attitude and care I get have got to be the best.  I can't think of any instance where I wasn't treated less than great.

I am constantly surprised to read of so many clinic staff NOT 'caring' for dialysis patients in the same caring manner that I receive at DCI.

A reporting structure should be required, management needs to be held accountable for the action, or inaction and attitudes of their employees.  Granted, patients do not have a lot of choice of which clinic they may be forced to use as in many areas there is not a selection of clinics. If there were then I'm sure there would be many empty seats in a lot of places as few would return to any place with substandard treatment.   Even poor staff attitude would prevent many from returning if given a choice.

So how do we go about getting a reporting system started?

What can I do as an individual to help?

[hatedialysis2]

So how do we go about getting a reporting system started?

What can I do as an individual to help?

Here is the mission of the LeapFrogGroup: 
 
"Founded in 2000 by large employers and other purchasers, The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps forward in the quality and safety of American health care. The flagship Leapfrog Hospital Survey collects and transparently reports hospital performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions. The Hospital Safety Score, Leapfrog’s other main initiative, assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents, and infections."

Dear owners/moderators of HD2: What are your thoughts on reaching out to this group to add dialysis clinics to their survey and reporting?

[Simon Dog]

I have have had excellent treatment by my home clinic (FMC), as well as some DaVitas I have visited.

One thing that is needed is full disclosure of limits imposed by financial policies.  For example, nobody at FMC gets a 200 or 250 filter unless the PMT committee has determined it medically necessary (note: Proving a 200 or 250 would be better is not sufficient, it must be necessary to get "adequate" dialysis).   At my home clinic, I was denied a Tegaderm dressing for my catheter since those cost $1 each, and therefore, takes an MD order (which was in place by the next treatment, but only because I have an excellent doc).

Patient education is the key.  For example, when you go into the hospital, you should know the facility policy on how often IVs are changed.   Nurses commonly "forget" to change them when due, hoping someone on another shift take care of it.  Ditto for wound dressings.

[Charlie B53]

.......... when you go into the hospital, you should know the facility policy on how often IVs are changed.   Nurses commonly "forget" to change them when due, hoping someone on another shift take care of it.  Ditto for wound dressings.

       CHANGE ?   an IV???    I have a hard enough time getting one in, often taking three Nurses trying multiple sticks each before getting 'In'.      And now you tell me that they need to repeat this terror on a regular basis??


Just one more reason I try NOT to go into any hospital.    I stay home until the Wife calls someone to come drag me off.

Long ago they used to give me a BIG shot of demerol or something like that.  Come back 20 minutes later and do whatever they want.  No problem.    They never should have quit that!

[Simon Dog]

IVs are supposed to be changed every few days, and each hospital has its own policy.  IVs should be marked with the date of insertion, and the floor nurses are responsible for checking the date and replacing the IV (or, calling the IV team if there is one) when the IV "expires".   Nurses, and people in general, can be ergophobic.   It is VERY common for RNs to conveniently miss the expiration date, or if the actual date hits, leave it for the next shift.

If the IV breaks off and leaves a part inside you during insertion or removal, be sure to have the RN put a tourniquet on STAT and page the MD.  You don't want that sucker migrating deeper into the body where it will be harder to remove.

Finally, there is something ironic about a dialysis patient calling IV insertion a "terror"

[Charlie B53]

I am still only three years into PD.  Haven't had the pleasure of becoming a 'full' Dialysis patient, yet.

[Simon Dog]

I am still only three years into PD.  Haven't had the pleasure of becoming a 'full' Dialysis patient, yet.

I wish you many more years of PD.  I only lasted 6 months.