Primaris Press Release
| Originally published in Journal of the Greene County Medical Society: February, 2007 |
Contact: Matt Heger Primaris Communications Department (800) 735-6776, Ext. 136 |
Needling ESRD Patients
Matt Heger, BS, Primaris
There’s high risk, and then there’s high risk.
In its influenza recommendations, the CDC lists five groups for which the adaptable virus is particularly menacing. Most physicians can recite these like a Boy Scout reading the Pledge of Allegiance: young tots, the pregnant, the 50+ crowd, those in long-term care facilities and those with certain chronic conditions. Four of these are fairly straight-forward. The last, however, leaves some room for interpretation.
To ensure that it’s brutally clear, end stage renal disease (ESRD) patients should be immunized.
Dialysis patients have long been recognized as a vulnerable and underserved population that would benefit from immunizations. Despite being immunocompromised, they are under-immunized for both influenza and pneumonia. Providing vaccinations for them will result in reducing the risk of hospitalization and death from these infections.
In 2005, The Centers for Medicare & Medicaid Services (CMS) identified increasing influenza and pneumococcal immunizations in ESRD facilities as one of its many “breakthrough” initiatives aimed at improving healthcare for the Medicare population. The ambitious objectives for this initiative are to increase the annual ESRD patient influenza vaccination rate to 90 percent by 2010 and to increase the lifetime ESRD patient pneumococcal vaccination rate to 90 percent by 2010.
According to the Healthy People 2010: 2005 Annual Report, influenza vaccination rates in ESRD patients reached 53 percent in 2003, still far from the goal of 90 percent. Many employers and providers, however, offer free or reduced cost vaccinations, which are not tracked in the Medicare data. More patients age 17 and younger are vaccinated, but the number reached only 25 percent in 2003, compared to 65 percent in those 75 and older. Vaccinations for pneumococcal pneumonia were given to only 13 percent of ESRD patients overall in 2002–2003, and less than 7 percent of pediatric patients. Providers clearly need to create vaccination protocols.
Currently there are over ten thousand patients receiving dialysis and kidney transplant services in Iowa, Missouri, Kansas, and Nebraska. The Quality Improvement Organizations in each of these four states (Iowa Foundation for Medical Care, Primaris in Missouri, Kansas Foundation for Medical Care and CIMRO in Nebraska) are working collaboratively with End Stage Renal Disease Network No. 12 to raise the awareness among healthcare providers of the need to improve immunization efforts within this high-risk group of people.
The issue is growing in importance. The United States Renal Data System (USRDS) predicts that ESRD incidence and prevalence counts will increase by 44% and 85%, respectively, from the year 2000 to 2015. Incidence and prevalence rates per million population by 32% and 70%, respectively. Diabetes and hypertension remain the leading causes of ESRD, with many patients suffering from additional co-morbid conditions as well.
The 90 percent goal set by CMS is no doubt lofty. However, by tracking immunization, encouraging patients, raising awareness, dispelling myths and, most importantly, providing the vaccine, it is entirely in our reach.
(Sources: ESRD Network 12, USRDS; CMS; and the Healthy People 2010 - 2005 Annual Report)
Ms. Yelton has been the Quality Improvement Director of ESRD Network No. 12 since 1997. Her nephrology career began in 1982 and she has practiced in all modalities of renal replacement therapy. She is a member of the American Nephrology Nurses’ Association and a charter member of the Vascular Access Society of the Americas.
Mr. Heger writes and directs publications for Primaris, a nonprofit health care consulting firm which holds the Medicare Quality Improvement Organization contract for Missouri; CLAIM, Missouri’s state health insurance assistance program; and the Missouri Center for Patient Safety.
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MO-06-21-PR
This material was jointly prepared by Primaris, the Medicare Quality Improvement Organization for Missouri and ESRD Network #12 Contract Number HHSM-500-2006-NW012C while under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contents presented do not necessarily reflect CMS policy.
The analyses upon which this publication is based were performed under Contract Number HHSM-500-2006-NW012C entitled End Stage Renal Disease Networks Organization for the States (Commonwealth) of Iowa, Missouri, Kansas, and Nebraska, sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.