CQUINs: Attractive? or Mutton dressed as Lamb?

The CQUIN framework is a national framework for locally agreed quality improvement schemes. It enables commissioners to reward excellence by paying a quality increment to providers using NOS Standard Contracts if they achieve agreed quality improvement goals. The Specialist services CQUIN menu, that includes Dialysis and Kidney Transplantation has now been issued and commissioners are working with networks and providers to agree which ones individual kidney units will use in this coming year. I do hope  local Kidney Patients Associations and individual service users are also being consulted as part of these discussions.

The menu will contain the following options:

Renal dialysis
·         Increase number of patients receiving dialysis at home
·         Increase use of Renal Patient View
·     Proportion of patients with anaemia of CKD receiving maintenance anaemia treatment that have haemoglobin levels as per NICE guidance.

Renal dialysis
Renal dialysis 1: Home dialysis
Title: Increasing use of home renal dialysis
Description: To ensure patients are offered choice in their renal replacement therapy.  Increase number of patients receiving dialysis at home.  The Trust to achieve a minimum of …% by April 2012 compromising a minimum of  …% as peritoneal dialysis, including assisted Automated peritoneal dialysis and ..% of home haemodialysis.  Evidence that patient choice has been offered will be required if target not met. 
Rationale: To encourage the delivery of care closer to or at home, and to maximum convenience to the patient.   To drive down reliance on access to hospital based services, reduce exposure to risk of infection and manage down the cost of delivering an anticipated growth of 3% in the dialysis cohort.  To ensure patients are involved in the choice of their renal replacement therapy.

Renal dialysis 2: Increasing the use of Renal Patient View
Description: For Main Renal Units to actively encourage the use of Renal Patient View during nephrology outpatient attendance and to actively offer choice of patients with CKD to access Renal Patient View
Rationale: Encourage patients to become the centre of decision making  by enabling them to view their test results on line and therefore become more informed about their current health status. Improve patient involvement in care and increase patient awareness of their disease.

Renal dialysis 3: CKD anaemia treatment
Title: To ensure compliance with the CKD anaemia treatment NICE Guidance
Description: Percentage of patients with anaemia of CKD receiving maintenance anaemia treatment that have haemoglobin levels as per NICE guidance.  Target to be 90%
Rationale: Improves patient outcomes

Renal Transplantation
·         Increase number of patients receiving pre-emptive transplants – time to listing issue and pathway.  Proportion of patients on waiting list 6 months before dialysis commences.
·         Increase number of patients on dialysis receiving a transplant – time to listing issue and pathway. Proportion of patients that time to listing as per best practise pathway

Renal transplantation 1: Increase pre-emptive kidney transplantation
Title: To include the use of pre-emptive kidney transplantation
Description: To increase number of patients who are suitable for transplant to receive their transplant prior to starting dialysis (pre-emptive). Allocation of organs must be in line with NHS Blood and Transplant allocation guidance.
Rationale: Pre-emptive transplant optimises outcomes for patient. Issue of delay in time to joining the transplant list for chronic kidney disease (CKD) patients

Renal transplantation 2: Increase transplant rates
Title: To increase the number of suitable patients that receive a transplant
Description: Increase number of suitable patients on dialysis receiving a transplant.  Increase % of CKD 5 and CKD 4 patients (known to a nephrologist for 3 months and with progressive deterioration in renal function) to have a decision made regarding suitability for transplant.
Rationale: Transplant viewed as gold standard renal replacement therapy.  Increase number of patients suitable for transplant that are on the transplant list.