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IMproving Nursing HOme Patient Transitions

The residents of nursing homes are among the most vulnerable population in our nation and have the highest COVID-19 mortality rate. The CDC reported “During May 1–August 31, 2020, a total of 114,411 COVID-19–associated deaths were reported to NVSS [National Vital Statistics System] …Twenty-two percent of decedents died in a nursing home or long-term care facility.”1 CMS recognizes there is an opportunity for improvement in the care of dialysis patients transitioning between outpatient dialysis clinics and nursing homes therefore they have tasked the Network with identifying and spreading highly effective practices developed, past or future, to provide and maintain high quality of care during these transitions. At a minimum, CMS expects increased/improved the communication between these two organizations. 

Successful and safe transitions between healthcare providers is dependent on strong relationships built on effective communication. The Network is providing a toolkit with resources to assist with improving communication and transition processes. 



  • Gold JA, Rossen LM, Ahmad FB, et al. Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 — United States, May–August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1517–1521. DOI:
  • Yerram P, Misra M. Home Dialysis in the Coronavirus Disease 2019 Era. Adv Chronic Kidney Dis. 2020;27(5):442-446. doi:10.1053/j.ackd.2020.07.001