[The following text was distributed as a letter to each ESRD facility in Network 4, dated July 9, 2007, and is available as a PDF formatted file.]

Dear Colleague in the Care of CKD and ESRD Patients:

As you are aware, the Centers for Medicare & Medicaid Services (CMS) has charged the Forum of ESRD Networks with the responsibility of encouraging the establishment of a renal coalition within their individual Networks. The PennDel CKD Partnership was established in October 2005 as the result of this endeavor. The two-fold mission of the PennDel CKD Partnership is to aid in early identification of those at risk for Chronic Kidney Disease (CKD) and to increase the incident/prevalent fistula rate within ESRD Network 4 to meet the CMS goal of 66% by 2009.

The Partnership is comprised of many different organizations and professional backgrounds within the renal field. To address its two-fold mission, the PennDel CKD Partnership has broken into two smaller subcommittees: the CKD Subcommittee and the Fistula Subcommittee. Both workgroups will facilitate the dissemination of educational materials and links to resources.

When you see our logo in your mailbox, you can be assured that you are receiving valuable information to assist in meeting your treatment goals.

By linking together professionals from many different fields within the renal community, the PennDel CKD Partnership seeks to improve care across the CKD continuum. If you have questions, comments, or feel that you have an interest in contributing to this venture, please contact the PennDel CKD Partnership at penndel@nw4.esrd.net.

CKD Subcommittee

The CKD subcommittee's focus includes early referral of CKD patients to a nephrologist and surgeon. The secondary goal would then be early AVF placement prior to the initiation of renal replacement therapy.

The subcommittee provided education tools and information earlier this year that aided in the passing of the Pennsylvania eGFR (estimated glomerular filtration rate) legislation. This legislation mandates that any patient who has been tested for BUN and Creatinine levels will automatically have their eGFR calculation reported. Primary Care Physician (PCP) education is also part of this mandate. In collaboration with the National Kidney Foundation (NKF), a letter and informational packet were distributed to each Pennsylvania PCP; the distribution was made possible with the cooperation of the Pennsylvania Medical Society. Follow-up symposiums are being planned state-wide. An initiative to develop media coverage for the general population is also in the planning stages.

Fistula Subcommittee

The Fistula Subcommittee is committed to finding ways to assist clinics with meeting the new goal of a 66% prevalent fistula rate. To accomplish this task, the Subcommittee has made the following resources available to clinics:

Eleven (11) Change Concepts (format: PDF, size: 1.2 Mb) which outline clinical and organizational changes that can be adapted and applied locally to improve AVF prevalence and success.
Algorithm/Protocol (format: PDF, size: 58 kb) for the Referral and Placement of Permanent Vascular Access in New Dialysis Patients.
Sample Policy and Procedure: Cannulation of New Fistula (format: PDF, size: 94 kb).
Article: A Multidisciplinary Team Approach to Increasing AV Fistula Creation (format: PDF, size: 49 kb): a community based nephrology practice experience, found in Nephrology News and Issues, June 2003, written by Vo D. Nguyen, MD; Chris Griffith, MD; and Lynn Treat, BSN, RN, BA, CNN.
Video Series: "Creating AV Fistulae in ALL Eligible Hemodialysis Patients"

Additionally the Fistula Subcommittee has recently developed two brochures with accompaning posters. The brochures/posters entitled "The ABCs of Fistula Placement" and "How Do I Look?" have been designed and sized to be displayed together on a single bulletin board.

ABCs of Fistula Placement Brochure, Side 1 (format: PDF, size: 8.7 Mb)
ABCs of Fistula Placement Brochure, Side 2 (format: PDF, size: 444 kb)
ABCs of Fistula Placement POSTER! (format: PDF, size: 8.5 mb)
How Do I Look Brochure, Side 1 (format: PDF, size: 2.9 Mb)
How Do I Look Brochure, Side 2 (format: PDF, size: 262 kb)
How Do I Look POSTER! (format: PDF, size: 2.8 Mb)

To further our endeavor, the Fistula Subcommittee surveyed medical directors and head nurses from 152 clinics on the ESRD Network 4 Chairman Preferred and Gold Preferred List. The survey tool sought information regarding factors though to be associated with high AF Fisulta rates and how those factors impact these clinics. The survey had a 36% response rate and a great deal of information was gathered.

Members of the PennDel CKD Partnership

Administration

Paul M. Palevsky, MD, Chief, Renal Section, VA Pittsburgh Healthcare System, Chair, Medical Review Board, ESRD Network 4, Inc.
J. Edward Hartle II, MD, Director of Nephrology, Geisinger Medical Center
Judy A. Stevenson, MSN, Executive Director, ESRD Network 4

Fistula Subcommittee

James Bojtos, Kidney Options Educator, Fresenius Medical Center
Rabih Chaer, MD, Vascular Surgery, UPMC
Cindy L. Jester, MSN, RN, Compliance Nurse, Office of Health Facilities Licensing and Certification-Delaware
Walid Kassir, MD, Nephrology
Robert Kraynik, Facility Administrator, Dialysis Clinic, Inc.
Brian LaMendola, RN, BSN, Clinical Specialist, Vascular Access Center
Carol Lesnick, RN, Facility Administrator, Dialysis Clinic, Inc.
Lisa Maurer, LCSW, Social Worker, Dialysis Clinic, Inc.
Ellen A. McCullough, Group Facility Administrator, Davita - Presbyterian Medical Center
Dean Morris, MSSA, Patient Services Coordinator, ESRD Network 4
Laurie Rieger RT(R)(CV), Center Operations Manager, American Access Care of Pittsburgh
Diane Peck, RN, CNN, Facility Administrator, REA Access Center
Maggie Tatarek, RN, CNN, Director, Clinical Technology Support, FMCNA, ANNA Representative
William T. Tritsch, III MBA, BSN, Area Manager, Fresenius Medical Care