Diabetic Foot Care

A recent study published in the American Diabetes Association’s (ADA) journal Diabetes Care (http://care.diabetesjournals.org/content/early/2019/05/28/dc19-0296) using 2000-2015 USRDS data has shown that the rates of nontraumatic lower-extremity amputation (NLEA) among adults with ESRD and diabetes fell 44% between 2000 and 2013 from 7.5 to 4.2 NLEA per 100 person-years, while NLEA among ESRD patients without diabetes declined 31% over the same period, from 1.6 to 1.1 per 100 person-years.  Both reductions were highly statistically significant.  However, both rates flat-lined after 2013.

We want to stress the importance of improving patient and staff education on diabetes self-management and preventive foot care, in order to resume the reductions in these rates.  CDC’s recommendations on diabetic foot care can be found at https://www.cdc.gov/features/diabetesfoothealth/index.html.  The ADA’s input is at http://www.diabetes.org/living-with-diabetes/complications/foot-complications/foot-care.html in English and http://www.diabetes.org/es/vivir-con-diabetes/complicaciones/el-cuidado-de-los-pies.html in Spanish.

6/25 CMS Seeks Comment on Rural Hospital Payment Changes

CMS has proposed that they improve their payments to rural hospitals, in an effort to improve rural health in the US.  While this isn’t directly relevant to ESRD, it will certainly be relevant whenever a kidney patient needs services at a hospital in a rural area.  Find the Proposed Rule and Request for Comment at https://www.govinfo.gov/content/pkg/FR-2018-05-07/pdf/2018-08705.pdf, and a Notice of Corrections at https://www.govinfo.gov/content/pkg/FR-2018-06-20/pdf/2018-13152.pdf.  Comments are due by June 25, 2019.  For background information see https://www.cms.gov/blog/putting-our-rethinking-rural-health-strategy-action and https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Proposed-Rule-Home-Page-Items/FY2019-IPPS-Proposed-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending.

6/12+ Infection Control Tools

  • In mid-June 2019 a series of presentations on Infection Control, offering free CME/CE credits to physicians, nurses, and pharmacists, will expire.  CDC and Medscape produced them in 2017 with the intention that they’d be valid for two years.  The six presentations include Risk Recognition, Environmental Services, Medical Equipment, Nonsterile Gloves, Hierarchy of Controls, and Injection Safety.  Find them at https://www.cdc.gov/infectioncontrol/training/cme-info.html.

More Care Transitions Resources

The ESRD National Coordinating Center has prepared a list of “Key Messages” for National Care Transitions Week, which you can find at https://s3-us-west-2.amazonaws.com/nwrn.org/files/N/NCC/NCC.NCTA.Keys.pdf.  Other useful materials on the ESRD NCC website include:

11/13 CMS ED Measure Comment Request

As part of a contract with the University of Michigan to develop a quality measure on Hospital Emergency Department Visits, CMS has issued a call for public comments, which are due by 13 November, 2017.  For more information and comment instructions, see https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/PC-Currently-Accepting-Comments.html#0001 .

Self-Care

A new Harvard Business Review article on “The Value of Teaching Patients to Administer Their Own Care” includes an example of a self-care dialysis program at the Central Texas Nephrology Associates clinic in Waco, Texas.  Some excerpts:

  • “In 2016, nearly 40% of CTNA’s 751 patients performed their own dialysis while experiencing fewer hospitalizations and a lower mortality rate than patients receiving dialysis the conventional way.  Patients delivering their own dialysis experienced better outcomes and the health system minimized costs by avoiding unnecessary hospital visits.”
  • The “Providers’ role changed from performing every step of the process to serving as coaches and supporters of patients doing their own care.  The resulting redeployment of staff resources led to higher productivity and throughput for the clinic.”
  • “Regardless of the setting, a successful approach to patient-administered self-care requires the following:
    • “Patients or caregivers must be prepared and willing… Care organizations need to develop a standard process for training patients… Practitioners must be trained to support patient-administered care, …to see themselves as coaches and the patient as an integral partner, …[to] recognize that patients’ capabilities to provide their own care may differ and evolve over time, and …to connect with the patient…
    • “A standard protocol should be developed [including] …methods for distributing equipment, supplies, and medication …how patients and providers should respond to adverse events …easy access to outpatient and inpatient services to address any needs that arise.
    • “A care organization that has [an outcome]-based-payment system will have a much easier time adopting the self-care model …Patient-administered care realizes savings by avoiding spending in the first place; in a fee-for-service model, this is lost revenue.”

Find the article at https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care .