dialysis vascular access in colombia: lessons for the usa ...€¦ · dialysis & vascular...
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Dialysis & Vascular Access in Colombia: Lessons for the USA
Jaime Velez, MD
DALLAS TX ‐ MAY 2014
DICLOSURES
Nephrology and Dialysis Transplantionhttp://www.era‐edta.org/newsletter_ndt_south_america.htmlMarch 2014
TOTAL PATIENTS CKD‐E5DCOLOMBIA 2008 ‐ 2013
TOTAL PATIENTS CKD‐E5COLOMBIA 2008 ‐ 2013
Health Insurance Company
RENALUNITS
Health Care Provider
Colombian worker and employer MUST contribute 12.5% of salary
HIRE
REPORT NATL GOV RPT
2006
4520 PREVALENT PATIENTS HEMO RTS OCT/’06
DISTRIBUTION OF VASCULAR ACCESS
25%
22%
49%
4%
TEMP CATHETER
PERM CATHETER
AVF
AV GRAFT
Health Insurance Company
RENALUNITS
Health Care Provider
Colombian worker and employer MUST contribute 12.5% of salary
HIRE
REPORT
SOLUTION WITHHIGH COST ACCOUNT
“HIGH COST ACCOUNT”
• ORGANIZATION MANDATED BY LAW IN 2007.
• INSURANCE COMPANIES NOW HAVE A “UNITED FRONT".
• THIS APPROACH IS HAVING A GREAT IMPACT ON HIGH COST DISEASES.
FUNCTIONS OF THE HIGH COST ACCOUNT: • CREATE RISK MANAGEMENT MODELS OF CARE.
• MEASURE THE ACTUAL FREQUENCY OF DISEASES AND ITS DISTRIBUTION.
• IDENTIFY DEVIATIONS FROM NORMAL OCCURRENCES.
www.cuentadealtocosto.org
RESULTS JUN 2013 Clinical Indicator : >18 y/o and > 90 days in therapy
HIGH COST ACCOUNT
CLINICAL INDICATOR FOR VASCULAR ACCESS YR % PREVALENT PTS WITH CATHETER
2006 43
2011 28
2012 14
2013 17
Health Insurance Company
RENAL UNITS
Health Care Provider
Colombian worker and employer MUST contribute 12.5% of salary
WILL NOT HIRE RENAL UNITS WITH RED LIGHTS
REPORT SOLUTION WITH
HIGH COST ACCOUNT
H.C.A COLLECT, ANALYZEAND PUBLISH
EVERY YEAR
HAS HIRED RENAL UNTS WITH GREEN LIGHTS
RECEIVE
Sources: 1. RTS: RENIR (Network Clinical Database), Dec 2010. 2. Poster accepted for ASN 2011
Continual Improvement in Overall HD Clinical Quality Standards
RTS Clinical Quality Assurance Process ensures continuousimprovements in attainment of HD clinical quality standards
AVF Usage Increased While Catheter Use Decreased1,2(n=4,855)
% AVF Proportion% Catheter Proportion
Pro
porti
on o
f Vas
cula
r Acc
ess
per P
atie
nt
Improvement in Achievement of HD Clinical Quality Standards Over 4 Years1,2 (n=4,855)
Pro
porti
on o
f Pat
ient
s
Anemia Hb>11gr%Optimal Dialysis Dose Kt/v sp>1.2
Adverse event occurrences (rate per 1,000 patients)Clotted dialyzer (rate per 1,000 patients)
Adjustment of the Clinical Coordinated Model of Care
With Permission from Baxter
TYPES OF VASCULAR ACCESSADVANTAGES AND DISADVANTAGES
AVFs
TRANSPOSITIONAV GRAFTS
WORST:THE CATHETER
PROTOCOLS MONITORING & SURVEILLANCE
ANEURYSM THROMBOSIS STENOSIS
STEAL SYNDROMEVENOUS
HYPERTENSION INFECTION
INSTEAD OF THIS …
RESULTNETWORK OF
VASCULAR SURGEONS:
• OPPORTUNITY FOR MEDICAL CONSULTATION WITHIN 5 DAYS
• SURGICAL OPPORTUNITY WITHIN 5 DAYS
HIGHLY SPECIALIZED & CERTIFIED NURSES:
• PROPERLY USING DIFFERENT PUNCTURE TECHNIQUES
• DETECTING TIMELY VASCULAR ACCESS DYSFUNCTION
NEPHROLOGISTS:
• LEADING THE TEAM
• FULLY RESPONSIBLE FOR ENFORCING THE CLINICAL INDICATORS
CONFIDENTIALWITH PERMISSION RTS – DATA SYSTEM
14 1219
1219
1521
1611
1611
86 8881
8881
8579
8489
8489
jun ago oct dic mar-12 jun sept dic mar-13 sept dic
%% VASCULAR ACCESS INCIDENT PATIENT
Jun Aug Oct Dec Mar 12 jun sept dec mar 13 sept dec
CONFIDENTIALWITH PERMISSION RTS – DATA SYSTEM
74 7572
77 76 78 8083 81
84 85
26 2528
23 24 22 2017 19
25
15
jun-08 ago oct dic mar-12 jun sept dic mar-13 sept dic
%
%VASCULAR ACCESS PREVALENT PATIENT
HIGH TECHNOLOGY RESEARCH AND “FIRST IN MAN” CLINICAL TRIALS
CLINICA AMIGA CALI COLOMBIA
LATIN AMERICAN TRAINING VASCULAR ACCESS CENTER
VASCULAR ACCESS CENTER : 800 AVF PROCEDURES PER YEAR
THANKS!!!!