Let All Flowers Bloom: Encouraging Innovation in Kidney Supportive Care through Partnerships with ESCOs—The Pathways Project (FR405)

Abstract

•Describe the fourteen best practices for supportive kidney care developed for the Pathways Project change package.•Discuss the opportunity that the ESCO accountable care model provides for innovating and integrating palliative care into the continuum of kidney care.•Assess the potential for leveraging value-based purchasing arrangements to foster integration of supportive care practices in your own community. The current care of patients with advanced chronic kidney disease (CKD) and end stage renal disease (ESRD) in the U.S. is not patient-centered, nor does it utilize palliative care approaches to optimize patients’ quality of life. In several recent studies, patients with ESRD compared to patients with other chronic diseases have received the most intensive treatments at the end of life including cardiopulmonary resuscitation, intensive care unit admission, mechanical ventilation, and feeding tube insertion. The Pathways Project, which originates from Quality Insights’ Coalition for Supportive Care of Kidney Patients, seeks to address this deficit through the implementation of an 18-month national Collaborative funded by the Gordon and Betty Moore Foundation. Fourteen teams consisting of nephrology and palliative care staff from ESRD Seamless Care Organizations (ESCOs) are participating (ESCOs are an ACO-type model just for dialysis patients). The Pathways Project developed a change package which consists of 14 evidence-based practices which the Collaborative teams are to test, implement, and evaluate. Examples of these best practices are identifying seriously ill patients, implementing advance care planning and shared decision-making, providing medical management without dialysis as an alternative to dialysis, and offering palliative dialysis and systematic dialysis withdrawal for appropriate patients. The Pathways Project developed the change package and associated tools and resources with input from the Pathways’ interdisciplinary Technical Expert Panel (TEP), which included patient subject matter experts. This session will introduce these best practices and describe successes and roadblocks encountered in implementing them within nephrology and dialysis settings. The session will also describe the latest results from the CMMI ESCO demonstration and discuss how palliative care aligns with the ESCO goals. Speakers will guide participants in assessing the readiness of their palliative care service to build bridges with ESCO models and dialysis centers in their community to strengthen nephrology/palliative care collaboration.