NN&I - June 2010

36 Nephrology News & Issues June 2010Subscribe to our free eNewsletter at www.nephronline.comRehabilitation Update Background Since the Conditions for Coverage were first released in April 2008, social workers across the country have worked to integrate the KDQOL-36 into practice. This process has been supported by education from dialysis organizations, the Council of Nephrology Social Workers, the KDQOL Working Group, and the Medical Education Institute. With the recent addition of the KDQOL Complete into the social workers "tool belt," the KDQOL-36 is beginning the evolu-tion in practice from a social work activity to an interdisci-plinary tool managed by the social worker. This evolution is consistent with three principles of the Conditions for Coverage identified in the preamble: an interdisciplinary approach of patient assessment, care plan-ning, service delivery, and quality assessment and perfor -mance improvement (494.80), patient centeredness (494.70, 494.60(c)) and outcomes-oriented model (494.110).1 Condition 494.90, Psychosocial Status, captures the spirit of each of these principles. This condition begins with, "The interdisciplinary team must provide the necessary moni -toring and social work interventions" [Interdisciplinary]. Patient centeredness is included in the next phrase: "These include counseling services and referrals for other social services, to assist the patient in achieving and sustaining an appropriate psychosocial status\205" Finally, the effect of interdisciplinary psychosocial intervention is measured by the use of "a standardized mental and physical assessment tool chosen by the social worker, at regular intervals, or more frequently on an as-needed basis."1As was described by Prescott,2 the KDQOL-36 is the preferred standardized tool identified in the Interpretive Guidelines. The ongoing challenge faced by social workers is integrating this tool into meaningful intervention for the patient and the interdisciplinary team. In order to do this, KDQOL-36 and the interdisciplinary teamBy Renata Sledge, LCSW Ms. Sledge is a clinical social worker with RAI Care Center Lincoln Hwy in Fairview Heights, Ill. And was part of the corporate team that developed and implemented the Conditions for Coverage rollout and training. In addition, she managed the introduction of the KDQOl-36 and KDQOL COMPLETE to RAI Care Centers. Abstract Social workers are challenged with integrating the Kidney Disease Quality of Life -36 survey results into meaningful intervention for the patient and interdisciplinary team. To face this challenge, the social worker and interdisciplinary team need an understanding of the background and research of quality of life measures, a process for completion of the survey, a tool to score the survey, and finally a process for interdisciplinary development of goals based on survey results. This article reviews the conditional requirements for administering a quality of life survey and the model used to intro-duce the survey to center practice.the social worker and interdisciplinary team need an under -standing of the background and research of quality of life measures, a process for completion of the survey, a tool to score the survey, and finally a process for interdisciplinary development of goals based on survey results. Introduction of survey to the interdisciplinary teamRenal Advantage Inc. introduced the interdisciplinary team to the KDQOL-36 in two stages. The new Conditions for Coverage and organizational policies were introduced to all regional management and regional training teams two months before the Conditions for Coverage became effective. Regional training teams included center directors, social workers, and dietitians. This introduction defined health-related quality of life as "a person or group's perceived physi-cal and mental health over time."3 Regional training teams were informed that, in addition to measuring how a patient's life has been altered by dialysis, health-related quality of life predicts morbidity and mortality. Low physical component scores (PCS) demonstrated increased risk of death, with only serum albumin and serum creatinine more predictive of death.4,5 Further, PCS is demonstrated to be a distinctive mea-sure for risk of hospitalization.4,6 Measure of PCS/MCS allows the treatment team to address the primary goal of decreas- ing morbidity and mortality as well as maximizing functional well-being.4 As Witten7 describes it, a quality of life survey Rehabilitation_NNI0610_3.indd 36 5/17/10 3:51:31 PM