1

The Beginning—August 2018

Identified goals for the clinic

Transplant was an area needing

improvement

2

The Clinic—April 1, 2019

Nineteen in-center hemodialysis chairs

Home therapies Peritoneal dialysis (PD) and home hemodialysis (HHD)

Census: 153

Age range: 22–94

Average age: 61.1 years

Range of length on dialysis: 1 month–18 years

Average length of time on dialysis: 4.4 years

Spanish-speaking patients: approximately 50%

English-speaking patients: approximately 50%

3

Tracking Transplant Referrals and Evaluations

Transplant tracker

What information did we need?

4

What Information Do We Want to Track?

As part of her work at City Dialysis, Fordham MSW Intern, Lauren Rafelson, reached out to the transplant centers directly to ensure our tracking information was accurate and to start to build relationships with those centers.

The information we collected included: Date the patient was first seen at the transplant center

Whether or not the patient followed up with required tests

Phase the patient was in○ Referral, evaluation, active and listed, inactive, or listed

5

What Information Do We Want to Track? (cont.)

Date and time of the patient’s next appointment

Next steps for a patient in the evaluation phase

to progress to the active and listed phase

Name and contact information for the

transplant coordinator

Transplant center’s perceived barriers

6

Root Cause Analysis: Start by Talking to the Patients

By talking to our patients, we found that:

Most actually did not know the referral and

transplant evaluation process.

Some thought they were listed “somewhere.”

Many had started the process of referral in

the past but “nothing ever came of it.”

7

Why the Confusion and Lack ofUnderstanding?

Educational materials were available.

How did patients not know if they had been

evaluated or listed?

What happened that “nothing ever came of it?”

8

Now We Ask Why—Again and Again

Every answer to that question was

related in some way to communication

and trust.

9

Changing the Culture

This change required:

A team of committed and compassionate staff

who are invested in the clinic and the patients.

A focus on developing our relationships with

the patients.

No more lip service. We had to show the patients that their health and

overall wellbeing were our priorities.

10

Where Did We Start?

The first step was to build relationships

and trust with the patients.

It was important to build an alliance

with the patients toward a mutual goal.

11

Who We Asked for Help

Transplant social workers

Transplant coordinators

Organizations in the community

We educated ourselves and did our own research.

12

“Project ECHO® (Extension for Community Healthcare

Outcomes) is a movement to demonopolize knowledge and

amplify local capacity to provide best practice care for

underserved people all over the world. The ECHO model™ is

committed to addressing the needs of the most vulnerable

populations by equipping communities with the right

knowledge, at the right place, at the right time.”

13

Project ECHO®: Right Knowledge.

Right Place. Right time.

Project ECHO®

Launched in 2003 by Dr. Sanjeev Arora of the University of New Mexico

Dr. Arora is the Project ECHO Founder and ECHO Institute Director and author of Project ECHO: Expanding the Capacity of Primary Care Providers to Address Complex Conditions*

For more information about the University of New Mexico and Project ECHO®, visit their website at: https://echo.unm.edu

*Cases in Global Health Delivery, March 2017

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Four Principles of the ECHO Model

Use technology to leverage scare

resources

Share “best practices” to reduce

disparities

Apply case-based learning to master

complexity

Evaluate and monitor outcomes

15

DATE TeleECHO Clinic

DATE (Dialysis and Transplant Echo) is a pilot

project by NYKidney using the ECHO model™ to:

Share best practices

Discuss real life cases to reduce barriers

Increase awareness

Review recent developments in transplant

Collaborate with multiple disciplines from multiple

organizations and institutions

in order to increase the number of successful kidney transplants.

16

Participation in the DATE ECHO

Meetings were:

By video conference.

Every other week for 14 weeks.

Attended by multiple disciplines from multiple

organizations and institutions.

Meetings provided an opportunity to share

challenges and barriers to transplant and

discuss ideas and suggestions about how

to overcome those barriers.

17

What Else Did We Do?

We created an educational environment

where the patients would become curious

and ask questions by introducing:

Monthly educational topics.

Fun activities such as celebrating patients’

birthdays and when patients had permanent

accesses placed.

18

Some of Our Monthly Educational Themes

19

Lobby Day for the NYC NKF Kidney Walk September 2018

20

Halloween Costume Contest 2018

21

• The staff dressed up

for Halloween and the

patients voted for the

best costume.

• The winners were

announced on the

treatment floor.

• We had blank paper

masks and crayons so the

patients could make their

own Halloween masks.

• Every patient got a “trick-or

treat” of an apple and a

small bag of pretzels.

Transplant Center Lobby Days

We:

Invited the seven transplant centers in

New York City to our clinic for Lobby Days.

Connected patients with their transplant

center of choice.

22

CKD Champions: Peer Support

CKD (Chronic Kidney Disease) Champions is

an organization in New York City created by

dialysis patients, Dawn Edwards and

Stephanie Dixon, who recognized the benefits

and need for peer mentorship and education.

They are committed to spreading awareness of

kidney disease and educating patients and the

provider community to help patients make

good choices and improve their quality of life.

23

CKD Champions Lobby Day March 2019

24

Fordham MSW

Intern, Matthew

Egan, identified a

lack of peer

support and

arranged a Lobby

Day with CKD

Champions.

Dawn Abrams

Stephanie Dixon

Field Trip!

Living donor transplant

surgery.

We look forward to

strengthening these

relationships to help

minimize the separation

between dialysis centers

and transplant programs.

25

Barriers We Are Still Facing

Tracking methods Adjustments are needed.

Transplant tracker use All staff need to be encouraged to add to the

transplant tracker.

Lack of cooperation from some transplant centers Not all of the transplant centers have been receptive.

Two centers declined our invitation for Lobby Days.

One transplant center has an incredibly difficult-to-

navigate referral process.

Not all transplant information is in Spanish

26

Listed and Active as of April 1, 2019

Of the original 20 patients active in January:

One patient transferred to another clinic.

One patient became inactive due to change in

medical condition.

Eighteen patients remained listed and active.

Three additional patients became active since January.

Currently there are 21 patients listed and active.

27

Evaluation as of April 1, 2019

In January: 23 patients were being

evaluated and 3 of those subsequently

became active and listed.

20 patients carried over from January.

An additional 7 patients have started the

evaluation process since January.

27 in the evaluation phase.

28

Our numbers

During the six months prior to our

transplant initiative, January 1, 2018 –

July 31, 2018, 1 patient received a

transplant .

August 1, 2018 – December 31, 2018, 4

patients received transplants .

January 1, 2019- April 30, 2019, 1

transplant so far.

29

Were we Successful?

Not enough time has passed to

really determine cause and

effect.

30