Project Guidelines
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[1].
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 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. 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. Facilities will be notified in October if they have met the goal to graduate or will continue in the project during the next year.
Facility Selection: 30% of all Network service area chronic out patient 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
Reporting Forms:
- August Updates; QIA Checklist
- Webinar: MId-Point Best Practices Slides; Recording; ;Post-Test
- July Updates: Mid-Point Feedback: Worksheet PDF; Online Submission Form
- June Updates; Feedback and Data: Worksheet PDF; Online Submission Form
- May Updates; Feedback and Data: Worksheet PDF; Online Submission Form
- April Updates; Feedback and Data: Worksheet PDF; Online Submission Form
- February/March Updates; Reporting: Worksheet PDF; Online Submission Form
- January Baseline Data Collection Tool: Worksheet PDF; Online Submission Form
- RCA 5 Whys Tutorial Worksheet, Recording; Slides; Evaluation Form
January RCA Outcomes PDF
CROWNWeb Home Training Data Entry Guide PDF
Patient Interview Worksheet PDF
Seven Step Tracker Flyer PDF
QIA Activity Checklist PDF
Education Station
Education Station Sign PDF
Best Practices Tip Sheet PDF
Webinars
Home Therapies QIA Kick-Off Webinar
Review project timelines, report root causes to low home therapies training, and review project interventions for 2018.
Recording; Slides; Post 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
Crossword Puzzle: PD The Needle Free Option PDF
PAC Speaks Patient Newsletter:
Overcoming Needle Fear PDF
Home Hemodialysis PDF
National Resources
Medical Education Institute (MEI)/Home Dialysis Central (HDC)
MEI Patient/Care Partner Tool: My Life/My Dialysis Choice webpage
HDC Staff Tool: Method to Assess Treatment Choices for Home Dialysis (MATCH-D) webpage
Institute for Healthcare Improvement (IHI) Resources
- IHI Paper: Going Lean in Healthcare
- IHI Video Activity: A comparison of 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 www.ahrq.gov/shareddecisionmaking 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, academics, and other professionals.
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 | https://www.youtube.com/watch?v=gQEKQELNNlg&feature=youtu.be |
| April 10, 2018 | Bringing Patients Home | 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 Eduardo Zanatta, MBA | • 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:
Anna Bennett
Quality Improvement Coordinator
516-209-5474
abennett@nw2.esrd.net
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
FINAL GOAL:
7) Patient begins home modality training