CROWNWeb and its Impact on Vascular Access Data Collection

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CROWNWeb's vascular access collection screens collect a number of measures to help with the calculation of CPM data. A few of CROWNWeb's key data collection points for this area include:

Current Access Type
This field refers to the type of vascular access used to dialyze the patient during the last treatment that the user's facility provided that patient during the reporting month.

AV Fistula Usable Date
This field refers to the date the fistula was first used, even if that date was prior to the date the patient was first admitted to the current facility, or prior to the date regular chronic dialysis began.

AV Fistula Maturing
This field allows the facility to record that the patient has an AV fistula that is not yet ready for use as of the last treatment of the month at the user's facility.

Surveillance of AVG with intra-access flow performed
This field refers to whether the user's facility performed surveillance of the AVG with intra-access flow measurement, which is a required entry if surveillance for access dysfunction was performed.

CMS is in the process of reviewing all vascular access definitions for clarity and accuracy, and evaluating the need for changes based on feedback obtained from Phase 1 and Phase 2 CROWNWeb users. A complete list of the CROWNWeb vascular access choices and definitions is available at www.projectcrownweb.org.

Clinical Data Collection Period

As is the case with the current Fistula First collection efforts, CROWNWeb vascular access data are required to be submitted every month, allowing the Fistula First CPMs to be calculated each month.

Similar to the current CPM data collection process, most CROWNWeb CPM data will be calculated over a specified period each year. In CROWNWeb, data are required to be submitted for a three-month period each year for hemodialysis (HD) patients and for a six-month period each year for peritoneal dialysis (PD) patients.

Previously, the CPM Project required submission of data for October through December each year for HD patients and for October through March of the following year for PD patients CMS will announce the collection months for CPM data once CROWNWeb is implemented on a national level.

Using the Vascular Access Screen

The vascular access screens in CROWNWeb use a "progressive disclosure" approach, a programming methodology that simplifies the system's usability and minimizes data entry errors. This functionality enables and disables various fields based on users' selections. For example, CROWNWeb enables only the required fields once the user selects the vascular access method for a patient. Irrelevant fields remain “grayed-out” and unavailable. See Figure 1 for CROWNWeb's vascular access screen.

CROWNWeb also features a "carry-over" programming logic that saves users' time by allowing data such as vascular access type to transfer from month-to-month. CROWNWeb users are required to enter a patient's vascular access data monthly, in line with the current submission requirements of the Fistula First program. Knowing that the access type for patients does not change often, CMS formatted the vascular access screen to allow a majority of the fields to duplicate the information entered in the previous month. While the vascular access information in the system can be changed when necessary, this automatic replication will save users time when entering information for a new month. Users still must review the information in the system each month, and indicate the patient's last treatment date (the last time the patient was treated at that facility for that month).




Figure 1: CROWNWeb's "progressive disclosure" approach.

CPM Data Comparison

CMS postponed the 2009 ESRD national CPM Project due to the phase-in implementation process of CROWNWeb, but will resume collecting and reporting this data once this new system is fully implemented. This postponement has given CMS an opportunity to further review how facilities will interact with the system by analyzing the data provided by participating Phase 1 and Phase 2 facilities.

Since December 2009, CMS has been reviewing CROWNWeb data for 3,446 facilities; this represents approximately 64% of all Medicare-certified ESRD facilities nationwide. Of these facilities approximately 180 are involved in Phase 2 (90 Independent dialysis units; and 90 Large Dialysis Organizations (LDO) facilities).

Additionally, data is being submitted via the "pilot" process of electronic data interface (EDI) for 3,267 approved batch data submission organizations, which, at this time are LDO facilities only.

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