Clinical Initiatives

Beyond striving to achieve industry-leading outcomes for our patients, DaVita^® and our physician partners are continuously innovating new programs to raise the standard for kidney care, reduce healthcare costs and improve access to care for all patients — not just our own.

It is not enough to focus our quality-improvement initiatives on individual clinical outcomes. If we truly want to shape the future of kidney care, we must look at our patients wholly and tailor treatments to their unique health conditions. This holistic approach, which includes vital services beyond dialysis, achieves three key results:

• The latest innovations developed through our internal research team are implemented first within DaVita facilities.
• DaVita’s care management options help forestall the progression of ESRD and reduce hospitalizations.
• Total healthcare costs for DaVita patients are lower on average than for patients of other dialysis providers.

With intensive collaboration, constant communication and unyielding focus, we and our physician partners are “moving the needle” on clinical care. To us, growth is not just continuously improving at what we already do, but branching out in innovative ways that benefit nephrologists and their patients.
 
A few of the many clinical initiatives that help DaVita physicians achieve excellent outcomes are:
 
IMPACT™ : By managing the four “A’s” — adequacy, access, anemia and albumin — we are reducing mortality among incident patients. Centers that implement the IMPACT program experience improved DQI (DaVita Quality Index)  scores, fewer unstable patients and more vascular accesses placed.
 
CathAway™ :This seven-step catheter reduction program is breaking down barriers to central venous catheter (CVC) removal, such as patient refusal, sudden start to dialysis, and new fistulas not maturing. By changing the way our patients receive dialysis, DaVita physicians and teammates have helped them stay out of the hospital, take fewer medications, increase their quality of life and even prolong their life. Every day that a patient does not have a catheter reduces that patient’s individual risk of infection, thrombosis, hospitalization and death. We estimate that in the past two years CathAway has successfully transitioned more than 6,000 DaVita patients away from catheters.

In the last quarter of 2009 alone, DaVita gave back 158 years of life to catheter-free patients.

SHAPE (Stable Hemoglobin Anemia Program Effort protocol): SHAPE is a large-scale effort to manage anemia through computerized algorithms. The goal is to provide a protocol that, with greater than 90% adherence to protocol orders, achieves a high percentage of patients with Hb in the 10-12 g/dL target range, while maintaining excellence in below-target outcomes and minimizing above-target results. These targets are in the CMS Clinical Performance Measures (CPMs) for anemia management in dialysis patients, and are consistent with both the CMS pay-for-performance Quality Improvement Program (QIP) measures for dialysis facilities and the FDA prescribing information for Epoetin alfa.

lnfluenza vaccinations: Inspired by CDC recommendations, DaVita set out to build a “culture of immunity.” Not long ago in 2008, when the industry average was in the 60 percent range, DaVita reached 90 percent influenza vaccinations among patients and clinical workers. We have maintained that rate in the two years since, offering protection to those who cannot be immunized due to health complications.

DigiQIFMM: CMS requires dialysis facilities to hold quality improvement (QI) meetings as part of their conditions for coverage, but does not specify how they should be conducted. DaVita created a tracking form called QIFMM (Quality Improvement and Facility Management Meetings), and when this form went digital in 2010, it greatly accelerated the decision-making process for facility administrators launching improvement plans.

Zen Tool: Zen is a unique physician mineral and bone disorder (MBD) management tool that facilitates simultaneous review of key biochemical markers and provides guidance for adjusting related medications, including phosphate binders, vitamin D sterols, calcimimetics and diet counseling. A computer-generated report graphs individual patient trends, response to therapy and movement toward a combined goal.

MBD Scorecard: DaVita developed a combined MBD scoring system that evaluates, tracks and communicates the effectiveness of MBD management processes monthly at the facility level. Each facility is awarded a score determined by preassigned weights for each clinical indicator and based on a percentage of patients achieving key MBD targets.
 
In addition to improving the quality of care for all patients, these initiatives are helping to lower the cost of healthcare in the United States. Although ESRD patients comprise less than one percent of Medicare patients, they make up nearly seven percent of total Medicare costs, in large part because of hospitalization costs associated with their co-morbid care. By reducing hospitalizations through our holistic approach to kidney care, DaVita is generating significant savings to the American healthcare system.
 
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