Dialysis & Vascular Access in Colombia: Lessons for the USA

Jaime Velez, MD

DALLAS  TX      ‐ MAY 2014  

DICLOSURES 

Nephrology and Dialysis Transplantionhttp://www.era‐edta.org/newsletter_ndt_south_america.htmlMarch 2014

TOTAL PATIENTS CKD‐E5DCOLOMBIA  2008 ‐ 2013 

TOTAL PATIENTS CKD‐E5COLOMBIA  2008 ‐ 2013 

Health  Insurance Company  

RENALUNITS 

Health Care Provider 

Colombian worker and  employer MUST contribute 12.5% of salary 

HIRE  

REPORT  NATL GOV RPT

2006

4520 PREVALENT PATIENTS HEMO RTS OCT/’06

DISTRIBUTION OF VASCULAR ACCESS

25%

22%

49%

4%

TEMP CATHETER

PERM CATHETER

AVF

AV GRAFT

Health  Insurance Company  

RENALUNITS 

Health Care Provider  

Colombian worker and  employer MUST contribute 12.5% of salary 

HIRE

REPORT  

SOLUTION WITHHIGH COST ACCOUNT 

“HIGH COST ACCOUNT”

• ORGANIZATION MANDATED BY LAW IN 2007.

• INSURANCE COMPANIES NOW HAVE A “UNITED FRONT".

• THIS APPROACH IS HAVING A GREAT IMPACT ON HIGH COST DISEASES.

FUNCTIONS OF THE HIGH COST ACCOUNT: • CREATE RISK MANAGEMENT MODELS OF CARE.

• MEASURE THE ACTUAL FREQUENCY OF DISEASES AND ITS DISTRIBUTION.

• IDENTIFY DEVIATIONS FROM NORMAL OCCURRENCES.

www.cuentadealtocosto.org

RESULTS JUN 2013 Clinical Indicator : >18 y/o and > 90 days in therapy

HIGH COST ACCOUNT

CLINICAL INDICATOR FOR VASCULAR ACCESS YR % PREVALENT PTS WITH CATHETER

2006 43

2011 28

2012 14

2013 17

Health  Insurance Company  

RENAL UNITS 

Health Care Provider 

Colombian worker and  employer MUST contribute 12.5% of salary 

WILL NOT  HIRE RENAL UNITS WITH RED LIGHTS 

REPORT  SOLUTION WITH

HIGH COST ACCOUNT 

H.C.A COLLECT, ANALYZEAND PUBLISH 

EVERY YEAR 

HAS HIRED RENAL UNTS WITH  GREEN LIGHTS 

RECEIVE 

Sources: 1. RTS: RENIR (Network Clinical Database), Dec 2010. 2. Poster accepted for ASN 2011

Continual Improvement in Overall HD Clinical          Quality Standards

RTS Clinical Quality Assurance Process ensures continuousimprovements in attainment of HD clinical quality standards

AVF Usage Increased While Catheter Use Decreased1,2(n=4,855)

% AVF Proportion% Catheter Proportion

Pro

porti

on o

f Vas

cula

r Acc

ess

per P

atie

nt

Improvement in Achievement of HD Clinical Quality Standards Over 4 Years1,2 (n=4,855)

Pro

porti

on o

f Pat

ient

s

Anemia Hb>11gr%Optimal Dialysis Dose Kt/v sp>1.2

Adverse event occurrences (rate per 1,000 patients)Clotted dialyzer (rate per 1,000 patients)

Adjustment of the Clinical Coordinated Model of Care

With Permission from Baxter

TYPES OF VASCULAR ACCESSADVANTAGES AND DISADVANTAGES

AVFs

TRANSPOSITIONAV GRAFTS

WORST:THE CATHETER

PROTOCOLS MONITORING & SURVEILLANCE

ANEURYSM THROMBOSIS STENOSIS

STEAL SYNDROMEVENOUS

HYPERTENSION INFECTION

INSTEAD OF THIS …

RESULTNETWORK OF

VASCULAR SURGEONS:

• OPPORTUNITY FOR MEDICAL CONSULTATION WITHIN 5 DAYS

• SURGICAL OPPORTUNITY WITHIN 5 DAYS

HIGHLY SPECIALIZED & CERTIFIED NURSES:

• PROPERLY USING DIFFERENT PUNCTURE TECHNIQUES

• DETECTING TIMELY VASCULAR ACCESS DYSFUNCTION

NEPHROLOGISTS:

• LEADING THE TEAM

• FULLY RESPONSIBLE FOR ENFORCING THE CLINICAL INDICATORS

CONFIDENTIALWITH PERMISSION RTS – DATA SYSTEM

14 1219

1219

1521

1611

1611

86 8881

8881

8579

8489

8489

jun ago oct dic mar-12 jun sept dic mar-13 sept dic

%% VASCULAR ACCESS INCIDENT PATIENT

Jun Aug Oct Dec Mar 12 jun sept dec mar 13 sept dec

CONFIDENTIALWITH PERMISSION RTS – DATA SYSTEM

74 7572

77 76 78 8083 81

84 85

26 2528

23 24 22 2017 19

25

15

jun-08 ago oct dic mar-12 jun sept dic mar-13 sept dic

%

%VASCULAR ACCESS PREVALENT PATIENT

HIGH TECHNOLOGY  RESEARCH  AND “FIRST IN MAN” CLINICAL TRIALS   

CLINICA   AMIGA  CALI COLOMBIA 

LATIN AMERICAN TRAINING VASCULAR ACCESS CENTER 

VASCULAR ACCESS CENTER :  800 AVF PROCEDURES PER YEAR 

THANKS!!!!