Serious infections that require hospitalization are among the major risks of renal replacement therapy.

Infections can affect patients in any healthcare setting—e.g., peritonitis in an individual on peritoneal dialysis, septicemia in a hemodialysis patient, or something that is not directly related to the patient’s treatment such as a pulmonary infection or pneumonia. Infections are the second leading cause of death among hemodialysis patients.1

In 2011, the Centers for Disease Control and Prevention (CDC) estimated that about 37,000 bloodstream infections occur each year among kidney dialysis patients with central lines, and of patients who get a bloodstream infection from having a central line, up to one in four die.

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Furthermore, since 1993, hospitalization rates among hemodialysis patients have increased an estimated 47% for bloodstream infection and an estimated 87% for vascular access infection.2

The Centers for Medicare & Medicaid Services (CMS) requires that facilities establish and maintain a data-driven Quality Assessment and Performance Improvement (QAPI) Program that focuses on indicators related to improved health outcomes and the prevention and reduction of medical errors.3

This program, which is an element of the Conditions for Coverage for End-Stage Renal Disease Facilities (ESRD CfCs), requires facilities to implement an infection control plan.

Furthermore, § 494.80(d) of the ESRD CfCs indicates that facilities must perform monthly assessments of the frequency of patient hospitalizations to help develop patient treatment plan and expectations for care. These data must be continuously monitored and available for review during CMS survey visits.

For years, facilities have stored patient infection and hospitalization data in their internal computer systems or manually, but facilities now have the ability to utilize CMS’ CROWNWeb data collection system to assist them with their data management efforts, and as a means of reporting this data directly to CMS.

CROWNWeb Overview

CROWNWeb is a secure Web-based data collection system that is primarily used by Medicare-certified dialysis facilities to capture and report clinical and administrative ESRD data to CMS in real time.

The system retains pertinent information that is reported to CMS in support of the ESRD CfCs, ESRD Network goals, the CMS National Quality Strategy and the Three Aims, Dialysis Facility Compare (DFC), the ESRD Quality Incentive Program (QIP), as well as the United States Department of Health & Human Services’ National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination.

While the data collected in CROWNWeb are used to assist facilities with meeting the requirements of specific CMS initiatives, dialysis treatment providers can take advantage of the system’s ability to capture facility and personnel details, patient treatment summaries, and clinical performance data to support their efforts in using data to monitor facility performance and the quality of clinical care, and to identify opportunities for improvement.