PEAK CAMPAIGN LEARNING CENTER

Throughout the Campaign, the PEAK Learning Center will feature approaches that providers, health care professionals, and patients can focus on to improve survival in their first year of dialysis.

This month the Campaign spotlights two Best Practices—one centered on supporting patients and improving quality-of-life through self-management and a forthcoming practice in dialysis optimization. Previous Best Practices, including tools and resources to implement them, are available through links to the right.

The best practices have been recommended by the Patient/Family Engagement Expert Panel and the Technical/Curriculum Expert Panel. Each practice presents the interventions to achieve the practice, along with tools and resources for patients, healthcare professionals, and providers

PATIENT "TOOLS OF ENGAGEMENT" BEST PRACTICES

BEST PRACTICE #6

Support patient efforts to live the best possible quality of life through self-management.

HOW DO YOU ACHIEVE THIS BEST PRACTICE ?

  1. Monitor and support new dialysis patients by implementing a case management model that focuses on self-management and takes into account:
    • The patient's stage of adjustment
    • Barriers to accessing care promptly
    • Rehabilitation
    • Screening for depression
    • Any diabetic needs
  2. Support self management through knowledge-building; patients achieve optimum treatment and health outcomes by working with the provider to understand CKD progression, treatment, and self-management options (e.g., self-monitoring and decisionmaking) (FistulaFirst Breakthrough Initiative, Change Concept # 13).
  3. Assess self efficacy (a person’s belief or expectation that he/she has the capacity to accomplish certain tasks in order to achieve desired goals). Evidence indicates that increased self-efficacy in people experiencing chronic disease is associated with improved health outcomes (Lev & Owen, 1998; Loring, Gonzalez, & Ritter, 1999; Loring & Holman, 2003; Loring, Sobel, et al, 1999; Zrinyi, et al, 2003). Strategies Used by People to Promote Health (SUPPH) is a 29 item self-report that has been used to measure self care and self efficacy in the ESRD population (Lev & Owens, 1996).
  4. Use specific educational techniques to encourage, enhance, and support patient self-management. These include motivational interviewing, health coaching and other evidence-based patient empowerment strategies and techniques (FistulaFirst Breakthrough Initiative, Change Concept # 13).
  5. Encourage patients to use a Personal Health Record (PHR) and any other tools that assist patients in managing their health records.
BEST PRACTICE #6 TOOLS AND RESOURCES
BEST PRACTICE #6 FACT SHEET

TECHNICAL/CLINICAL BEST PRACTICES AND TOOLS

BEST PRACTICE #4: Evaluate and Maintain Adequate Hemoglobin

Systematically test for anemia, establish intervention thresholds that take into account risks, benefits, and patient preferences, and intervene accordingly.

HOW DO YOU ACHIEVE THIS BEST PRACTICE ?

  1. Evaluate hemoglobin, creatinine, creatinine clearance and/or GFR. If the patient is anemic, evaluate cause of anemia (iron stores, ferritin, vitamin deficiency, inflammation, and consider merits of additional work-up).
  2. Treat underlying causes, considering target hemoglobin, quality of life, and patient and family goals.
  3. Rule out causes of non-response to treatment of anemia or its causes (e.g. inflammation, antibodies, aplastic anemia, lymphoma, gastrointestinal blood loss).
  4. Consider use of an ESA:.
    1. Identify ferritin cut-off for iron overload and use as a guide for utilization of ESAs.
    2. Establish therapeutic target.
    3. Establish monitoring schedule for labs and dose change.
    4. Establish CQI processes to track patient’s scheduled labs receipt of scheduled ESA doses, and patient’s response to ESA dosing to avoid under and overtreatment. Reschedule missed labs in a timely manner and develop a strategy to ensure ESA doses are not missed when patient moves between health care settings.
  5. Develop a communication strategy about approach and targets if care is shared with primary care physician.
BEST PRACTICE #4 TOOLS AND RESOURCES
BEST PRACTICE #4 FACT SHEET
 

Campaign Learning Center Resources

Right Start Program

Renal Physicians Association

Patient Tools and Resources

Technical/Clinical Tools and Resources

 
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