Vocational rehabilitation: is your facility on track?

The Conditions for Coverage for End-Stage Renal Disease Facilities require that facilities evaluate each patient for referral to vocational rehabilitation (VR) services, assist the patient in achieving and sustaining an appropriate level of productive activity, and develop a plan that reflects individual patient preference. Though research shows that people on dialysis who keep working feel better, data collected in the 2008 USRDS Comprehensive Dialysis Study indicates that only half of dialysis patients continued to work after starting treatment.

A review of the data and the reasons dialysis patients do not work provides an opportunity to identify resources and strategies to address barriers. FMQAI: The Florida ESRD Network (Network 7) initiated a quality improvement project in June 2008 to increase the percentage of Florida ESRD patients, aged 18 through 54, who were receivingVR services, attending school, or employed.

Using the 2007 ESRD Facility Survey (CMS-2744A) data as a baseline, Network 7 employed a two-pronged approach using both statewide spread efforts and focus group interventions with a targeted group of providers. All facilities identified in the focus group began the project with a baseline of 0% of patients ages 18-54 either engaged in VR, working, or in school. Quality improvement plan (QIP) workshops, conference calls, tracking tools, individualized facility data reports, educational materials, and technical assistance were utilized to improve VR rates in Florida.

As of December 31, 2008, Network 7 increased their statewide results (patients aged 18-54 either engaged in VR services, attending school or working) by 2.5% over the 2007 baseline. For the focus group, as of June 30, 2009, results indicate that 40% of patients are either engaged in VR, working, or in school.

By including VR in facility quality assessment and performance improvement (QAPI) activities, facilities can demonstrate outcomes-driven practice and enhance the independence and quality of life for ESRD patients.