Project Guidelines

IPRO ESRD Networks are tasked by the Centers for Medicare and Medicaid Services (CMS) to work with facilities to increase the use home therapies.

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, the following AIM with a 5-year target has been set to guide national health promotion and management to improve the health of all people in the United States living with ESRD: by 2023, to increase the number of ESRD patients dialyzing at home to 16% from the 2016 national average of 12%.  (The 2016 NY State average was 6%)

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

Goal: 10 percentage point increase in home therapies training over baseline.

Timeline: Facilities are selected and notified of their participation in January. The Network will work with the facilities to implement interventions.  Facilities will be notified in October if they have met the goal to graduate or will continue in the project during the next 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.

Facility Selection: 30% of all Network Service area chronic out patients dialysis facilities that treat in-center hemodialysis pateints. (stand alone home therapy facilities are excluded)   List of facilities in the 2018 HT QIA PDF

Baseline Data: The QIA baseline data was provided by the ESRD National Coordinating Center (NCC) from the facility submitted information available in CROWNWeb.

Re-Measurement Data: Data for this QIA will be extracted from facility monthly CROWNWeb data, and will be provided to the Network by the ESRD National Coordinating Center (NCC.)

Tools and Resources

April Feedback and Data Reporting tool:  Worksheet PDF; Online Submission Form

February/March Reporting Tool: Worksheet PDFOnline Submission Form

January Baseline Data Collection Tool  PDF Worksheet;  Online Submission Form 

RCA 5 Whys Tutorial  WorksheetRecordingSlides; Evaluation Form

January RCA Outcome PDF

Education Station/Huddle Materials

Education Station Sign PDF
Best Practices Tip Sheet PDF


February 5, 2018
National ESRD NCC Home Therapies LAN Event
Featured Presenters: Mark Shapiro, MD, DaVita; Eduardo Zanatta, MBA, DaVita

January 30, 2018
Home Therapies QIA Kick-Off Webinar

Review project timelines, report root causes to low home therapies training, and review project interventions for 2018.
Recording; SlidesPost Assessment

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

Lean Resources

Institute for Healthcare Improvement (IHI) Resources

IHI Paper: Going Lean in Healthcare
IHI Video Activity: A comparison LEAN and QI

AHRQ Shared Decision Making Resources

The Agency for Healthcare Research and Quality's (AHRQ)  SHARE Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each option through meaningful dialogue about what matters most to the patient.   Flyer PDF

The Agency provides a collection of tools and training resources to support the implementation of shared decision making in practice. Refer to to locate resources such as:

SHARE Approach Workshop Curriculum: Collection of training guides, slides, videos, and other resources to support the training of health care professionals on shared decision making and SHARE Approach implementation

SHARE Approach Tools:  Collection of reference guides, posters, and other resources designed to support AHRQ’s SHARE Approach implementation

SHARE Approach Webinars:  Accredited webinars that review topics related to the implementation of patient-centered outcomes research in shared decision making

SHARE Approach Success Stories:  AHRQ’s SHARE Approach tools and resources are used by organizations nationwide to implement shared decision making in health care. These case studies highlight stories of successes and best practices by describing the use and impact of the AHRQ’s SHARE Approach strategies and tools by health systems, clinicians, academicians, and other professionals.



For more information:

Anna Bennett
Quality Improvement Coordinator

The CMS defined seven steps 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.