Home dialysis 
Quality improvement activity (QIa)

Network Project Lead: Kou Kha-Moua

Studies show that patients who participate in home dialysis therapy experience greater independence and are able to dialyze at a slower rate, which is proven to produce a better physiological response. Patients who have home dialysis therapy also benefit from the following¹:
 

• Lower risk of death
• Improved blood pressure control
• Better quality of life
• Better phosphorus control to prevent bone disease
• Improvements in neuropathy, less restless leg syndrome
• Feel better during dialysis (less “washed out” feelings )
• More energy for daily tasks
• Better sleep
• Boosts independence, responsibility and confidence
• Continued employment
• Makes travel easier
• Fewer and shorter hospital stays

Despite of the benefits of home dialysis therapies, according to the United States Renal Data System (USRDS), home dialysis only accounted for 8.3% of all prevalent dialysis patients in 2016.² In addition, only 11.8% of Network 4’s ESRD patient population utilized a form of home therapy as of December 31, 2018. The long-term goal and impact of improving home modality initiation aligns with CMS’ priorities, and results in better health and lower costs for our patients. Network 4 will assist participating facilities as they guide patients through the 7 step process leading to home dialysis utilization: 
 

1. Patient interest in home dialysis
2. Educational session to determine the patient’s preference of home modality
3. Patient suitability for home modality determined by a nephrologist with expertise in home dialysis therapy
4. Assessment for appropriate access placement
5. Placement of appropriate access
6. Patient accepted for home modality training
7. Patient begins home modality training

Monthly Reporting Tool 

The Network will contact selected facilities and send a link on a monthly basis. 

Presentations & Materials

• QIA Kickoff Presentation Slides

Toolkit 

• Quality Improvement Videos
  • Quality Improvement in Healthcare (11:08 Minutes)
  • Root Cause Analysis – Process to Identify Areas for Quality Improvement
    • What is a Fishbone Diagram? (3:08 Minutes)
    • Root Cause Analysis: 5 Whys (4:44 Minutes)
  • PDSA Cycles – Process to Achieve Quality Improvement (6:21 Minutes)
• PDSA Tool

• Patient Evaluation Form  

• Patient Testimony
  • Ellyne Dombro, Patient
  • Timmy Nelson, Patient
• Brochure: Peer-to-Peer Program
• Brochure: Why Should I Choose Home Dialysis? 
• Home Dialysis Change Package
• 5-Diamond Patient Safety Program Home Therapy Module
• My Life, My Dialysis Choice
  • A tool to assess the modality which may best fit the patient’s value  
• Home Dialysis Articles
  • Thinking Outside the Box – Identifying Patients for Home Dialysis
  • Psychosocial Barriers to Home Dialysis: A Literature Review
  • Home Dialysis First: A New Paradigm for New ESRD Patients
• Conditions for Coverage
• Resources from the NCC
  • Uncovering the Myths about Home Dialysis: Myth vs. Reality Toolkit
  • "Best Wishes on the Decision to Dialyze at Home" Certificate Template

ESRD NCC Home Dialysis QIA Learning and Action Network (LAN) Calls

Please note that these dates are subject to change based on speaker availability. Meeting details, including registration link and call overview, to be provided prior to each call.
 

DATE	TIME
Tuesday, January 14	3:00 - 4:00 p.m. ET
Tuesday, March 10	3:00 - 4:00 p.m. ET
Tuesday, May 12	3:00 - 4:00 p.m. ET
Tuesday, July 14	3:00 - 4:00 p.m. ET
Tuesday, September 8	3:00 - 4:00 p.m. ET
Tuesday, November 10	3:00 - 4:00 p.m. ET

A PDF copy of the slides, recordings and continuing education credit opportunities are available by visiting the ESRD National Coordinating Center (NCC) QIA LAN web page.

2019 Home Dialysis QIA Materials

References

1. ​Young BA, Chan C, Blagg C, et al. How to overcome barriers and establish a successful home HD program. 2012. http://cjasn.asnjournals.org/content/early/2012/10/03/CJN.07080712.full.  

2. United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2018