2018 Population Health Focused Pilot
Quality Improvement Activity (PHFPQ)
Vocational Rehabilitation
For questions or technical assistance, please contact:
Brittney Jackson, LMSW, MBA
Patient Services Director
(203) 285-1213

A priority of the Network is to serve as a resource to both dialysis patients and professionals throughout PHFPQ activities.  Open communication about existing processes, barriers, and successes is encouraged.  Network staff members are interested in supplementing resources for what is working in your facility, not adding additional burden. However, in order to assess vocational rehabilitation barriers, and identify how the Network can effectively meet needs of the community, completion of the activities listed below is essential to success of the project.
Please note due dates associated with activities.

DISCUSS: Talk with dialysis team members and patients to identify root causes of barriers in vocational rehabilitation referrals/patient receiving services.

OUTLINE: Develop a Plan-Do-Study-Act (PDSA) cycle to address identified barriers.
Review:   January Webinar titled 2018 CMS Priorities, Goals, and Quality Improvement Activities Webinar  on our website http://network1.esrd.ipro.org/events/
Dear ESRD Dialysis Providers,
The Network is working with 20 facilities, representing 10% of the Network 1 service area.   In efforts to obtain a wide spread of patients and demographics, facilities from diverse regions in 5 of the 6 states in New England where chosen. Each state has vocational rehabilitation (VR) / employment network (EN) agencies that will collaborate with the Network and facilities throughout the quality improvement activity (QIA).

NOTE: Documentation of vocational rehabilitation status in CROWNWeb is vital, as it will be the source of measuring improvement at the facility-level.
Root Cause Analysis (RCA) Report
Participating facilities were asked to utilize the Five Whys RCA approach to determine the top 3 underlying issues that facility staff identified as potential causes for low referral rates for vocational rehabilitation services.
The data below illustrates the top three barriers facilities reported.
Issue 1: Patient Not Interested
Facilities reported patient not being interested in VR/EN services as the number one barrier associated with low patient enrollment. The Five Whys Analysis identified these additional reason associated with the high percentage of patient not being interested.
  • Patients do not want to return to work
  • Patients do not want to lose their disability benefits
  • Patients have other obstacles in their life such as limited time, family obligation, and lack of transportation
  • Patients feel that employers might think he/she is too sick to work
  • Patients have multiple medical issues occurring

Issue 2: Patient Feels Too Ill or Sick
 Facilities reported patients feelings too ill or sick for VR/EN services as the number two barrier associated with low patient enrollment. The Five Whys Analysis identified these additional reason associated with the high percentage of patient not being interested.
  • Dialysis replaces kidney function, but not perfectly
  • Patients feel too overwhelmed with the thought of working and dialysis
  • Patients do not feel that they can work in their previous or related occupation due to physical limitations and maintain their dialysis schedule and ancillary appointments
  • Patients felt that other medical conditions contribute to not being able to work
  • Deterioration of health status due to chronic illness
Issue 3: Lack or Transportation

Facilities reported lack of transportation as the number three barrier associated with low patient enrollment. The Five Whys Analysis identified these additional reasons associated with the high percentage of patients with a lack of transportation.
  • Patient does not have access to services to that will allow them to utilize vocational rehabilitation services or work.
  • Some patients do not own a car.
  • Patients have low income due to disability and limited work history.
  • Systemic intersectional poverty.
  • Friends and Family are not a reliable source for transportation needs.

Project Goals

* Participating facilities shall demonstrate a ten (10) percentage point increase in referrals to EN/VR agencies in by September 30, 2018.


* Participating facilities shall demonstrate a five (5) percentage point improvement in the number of patients receiving EN/VR services by September 30, 2018.

We Want to Hear from YOU!
Please contact the Patient Services Director if you have questions, comments, or specific barriers that you would like to address.  Let us know if you have identified any best practices that you would like to share with the community.