Table 1.

Effect of interventions in the ESRD Management Demonstration Project

DMO ADMO BDMO C
Impact of Pharmacist Involvement on Medication-Related Problems (Chapter 3)
  • Increase in medication-related problems over time

Management of CVD and Cardiovascular Risk Factors (Chapter 4)
  • Increase in ACEi/ARB use versus baseline among patients with congestive heart failure enrolled for one year, yet a decrease to below baseline at 2 years

  • No improvement in BP control among all enrollees

Improving Preventive Care Processes (Chapter 5)  
  • More patients received influenza and pneumococcal vaccinations in 2007 and 2008 than in FFS

  • Significantly more patients with diabetes mellitus received routine HbA1c tests in accordance with established guidelines compared with FFS and a nationally representative population of HD patients (U.S. DOPPS) comparison populations

  • More patients with diabetes mellitus received routine foot and retinal examinations by mid-2008 compared with U.S. DOPPS

Improving Advanced Care Planning (Chapter 6)
  • Slight increase in adoption of ACP for HD patients versus baselinea

Improving Diabetes Management (Chapter 7)
  • Increase in HbA1c tests for patients with diabetes mellitus during period of standing orders

  • Sharp decrease in HbA1c measurement among patients with diabetes mellitus after standing orders were discontinued

  • No significant change in achievement of the HbA1c target (HbA1c < 7%)

Changing Prescription Patterns of ACEi/ARB Use (Chapter 8)
  • Increase in ACEi/ARB use versus baseline among patients with persistent hypertension enrolled at least 2 years

Use of Oral Nutritional Supplement in Patients with Low Serum Albumin (Chapter 9)
  • Significantly reduced mortality among patients with the clinical indication to receive ONS as compared with the CMS ESRD Clinical Performance Project population

  • Increase in serum albumin among patients with the clinical indication to receive ONS.

Impact of Home Weight Monitoring on Clinical Outcomes (Chapter 10)
  • 42% of all patients participated in the HWM program; however, 70% of 2006 enrollees used HWM and only 16% of 2007/2008 enrollees ever used HWM

  • Short-term effect of reducing IDWG for patients on HWM

  • No sustained effect of HWM in IDWG after discontinuation

  • HWM was associated with lower all-cause and cardiovascular mortality and all-cause and cardiovascular hospitalization for 2006 enrollees but this association was not noted for 2007–08 enrollees

  • DMO, disease management organization; ACP , advanced care plans; HD, hemodialysis; ONS, oral nutritional supplements; CMS, Centers for Medicare & Medicaid Services; CVD, cardiovascular disease; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; HbA1c, hemoglobin A1c; HWM, home weight monitoring; IDWG, interdialytic weight gain; FFS, fee-for-service; CVD, cardiovascular disease; U.S. DOPPS, U.S. Dialysis Outcomes and Practice Patterns Study. Reprinted from reference 8.

  • a Analysis is limited by inconsistent ACP data, lack of an adequate comparison population, and the small number of patients included in the analyses.