IPRO ESRD Networks are tasked by the Centers for Medicare & Medicaid Services (CMS) to work with facilities to increase the utilization of home therapies.
Home dialysis modalities are underutilized in the USA with only 8% of patients utilizing home dialysis versus 92% being treated at in-center hemodialysis facilities.
CMS has set a 5-year target to improve the health of all people in the United States living with ESRD. This goal for 2023 is to increase the number of patients dialyzing at home to 16%. (The 2018 NY State average was 7%)
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. 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.
Criteria: Include at least 30% of facilities in Network service area
Goal: 2 percentage point increase in natural trend in home therapies utilization over baseline
Baseline Data: 5 year average trend of patients utilizing Home Therapies (10/2013 - 9/2018)
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). Final re-measure will be September 2019 data.
Tools and Resources
- January QIA Contact Reporting: Online Submission Form
- February Monthly Status Report Worksheet PDF; Online submission form
- RCA 5 Whys Tutorial Worksheet, Recording; Slides; Evaluation Form
National ESRD NCC Webinars (free CE to registered attendees):
2019 National ESRD NCC LAN QIA Call Schedule PDF
January 15, 2019 3:00pm-4:00pm ET Pre-work Questions link; Registration link
March 12, 2019 3:00pm-4:00pm ET
May 14, 2019 3:00pm-4:00pm ET
July 9, 2019 3:00pm-4:00pm ET
September 10, 2019 3:00pm-4:00pm ET
November 12, 2019 3:00pm-4:00pm ET
ESRD NCC Home Therapies QIA Webinars
|Date||Title||Presenter(s)||Objectives||Intervention Support||Recording Link|
|June 12, 2018||Care Innovation “A Transitional Care Unit”||Robert Lockridge, MD Lisa Hart, MSN, CNN||• Identify what is happening to patients in the first year of dialysis in the United States.|
• Educate attendees about the concept of a transitional care unit.
• Highlight how to set up a transitional care unit.
|• Step 1: Patient interested in home dialysis|
• Step 2: Education session to determine the patient’s preference of home modality
|April 10, 2018||Bringing|
|Shannon Cook, RN||• Share best practices that increase patients’ awareness of, and interest in, home dialysis.|
• Review education strategies that build and/or strengthen relationships between staff and patients to overcome barriers.
• Describe patient-centered activities that identify gaps between patients’ goals and current quality of life.
• Discuss strategies for overcoming
barriers that impact a patient’s perceived
suitability for home modalities.
• Share approaches that decrease home admission wait time through collaboration between regional home programs.
|• All steps||https://www.youtube.com/watch?v=huqngM8bE04&feature=youtu.be|
|February 5, 2018||Making PD Possible for More Patients||Mark H. Shapiro, MD|
|• Share demonstrated practices for peritoneal dialysis growth|
• Understand how planned and urgent starts impact peritoneal dialysis growth
• Learn about in-center hemodialysis (ICHD) to peritoneal dialysis (PD) conversions
• Examine patient retention
|• All steps||https://youtu.be/bI1TPTP1c2I|
For more information:
Quality Improvement Coordinator
Monthly HT QIA Newsletters:
Jan/Feb (Customer Focus)
CMS has 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