Promote Appropriate Home Dialysis

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Project Guidelines

IPRO ESRD Network of the South Atlantic is tasked by the Centers for Medicare and Medicaid Services (CMS) to collaborate with 30% of the dialysis facilities in the Network service area to support the efforts of increasing the rates of patients dialyzing at home.

Home dialysis modalities are underutilized in the USA with only 8% of the dialysis patients undergoing renal replacement therapy at home versus 92% being treated with center hemodialysis[1].

As a result, a 5-year target goal has been set by the Centers for Medicare and Medicaid Services (CMS) to guide national health promotion and management to improve the health of all people in the United States living with ESRD: by 2023, increase the number of ESRD patients dialyzing at home to 16% from the 2016 national average of 12%.

The intent of the Home Dialysis QIA is to promote referral to home dialysis modalities, identify and mitigate the barriers to timely referral, and determine the steps patients and providers can take to improve referral patterns. The Networks shall increase the number of patients on a home modality by participating in the ESRD NCC Home Dialysis LAN, and assisting dialysis facilities in the implementation of interventions to support patients through the process of training to dialyze at home.

[1] Thinking outside the box—identifying patients for home dialysis. Brigitte Schiller, Hayley Munroe, and Andrea Neitzer

Timeline:

Facilities were selected and notified of their participation in January 2018. The Network will collaborate and assist dialysis facilities with implementing interventions. Facilities will be notified in October 2018 if they have met the goal to graduate or will continue in the project during the next option year. Facilities not meeting goal should continue to implement interventions and strategies regardless of the measurement period to maximize their ability to graduate in future years.

Baseline Data:

The baseline data for dialysis facility inclusion was provided by the ESRD National Coordinating Center (NCC) from the facility submitted information available in CROWNWeb.

Facility Selection:

Thirty percent of all Network Service area chronic out patients dialysis facilities that treat in-center hemodialysis patients. ( ONLY stand alone home dialysis facilities are excluded, all others are included even if the facility does not have an on-site Home Dialysis Department)

Goal:

Ten percentage point increase in the rate of patients that start home dialysis training by evaluation of each option year based on the data provided by the ESRD National Coordinating Center (NCC) from the baseline period of October - June of the previous year. (This baseline data was extracted from the CROWNWeb database)

Re-Measurement Data:

Data for this Quality Improvement Activity (QIA) will be extracted from the facility monthly CROWNWeb data, and will be provided to the Network by the ESRD National Coordinating Center (NCC).

Network Calendars:

July 2018 Printable PDF
June 2018 Printable PDF
May 2018 Printable PDF
April 2018 Printable PDF
March 2018 Printable PDF
February 2018 Printable PDF

QIA Tools and Resources

Printable Patient Education Materials

Flyer: What are my treatment choices?   PDF
Booklet: Considering your treatment choices  PDF
Booklet: Know the Facts about Home Dialysis Choices PDF

Peer Mentors

Research and best practices have demonstrated that units with active participation of patients as members of the health care team achieve better clinical outcomes more readily. This year, the Network is requesting that each facility in the Promote Appropriate Home Dialysis QIA designate at least one patient, or preferably, one patient per shift to take the lead on special projects. We will provide training for these patients to supervise these programs in the clinic. Patients should be viewed as role models in the unit as far as the ability to lead and become "the unofficial spokesman" on the care team.

In this role, the patient will:

• Provide contact information to the Network.
• Participate in educational and information web conference presentations with the Network.
• Review educational materials designed for patients in the target facilities and throughout the Network community.
• Distribute and review resources with patients.

Peer Mentor Resources and Materials

Home Dialysis Central

My Life My Dialysis Choice

Webinars

January 31, 2018
Home Therapies QIA Kick-Off Webinar  Review project timelines, report root causes to low home therapies training, and review project interventions for 2018.  Slides; Recording; Post Assessment

January 17, 2018
RCA 5 Whys Tutorial Reviewing Root Cause Analysis and how to perform the 5 Whys
 Worksheet; Recording; Slides Evaluation Form

Lean Resources

Institute for Healthcare Improvement (IHI) Resources

IHI Paper: Going Lean in Healthcare

IHI Video Activity: A comparison LEAN and QI