Collaboration of Caring for Home Dialysis Patients

Although COVID-19 (coronavirus) is a current focus for most clinicians, DaVita Medical Insights continues to publish on other important clinical topics, some of which may be pertinent to the pandemic. Home dialysis is relevant to COVID-19, as patients treating at home may be able to limit exposure to the virus. This post covers some of additional advantages of home dialysis, along with some suggestions on how to provide home dialysis care as part of an integrated care model.

Those who work in nephrology understand the health and financial effects associated with kidney disease. For those looking through a clinical lens, the aim is to provide the best treatment in the most cost-effective way that improves patient outcomes. Home dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), is a viable choice as research shows potentially improved patient outcomes for clinically appropriate patients, in terms of quality of life and reduced mortality rates, compared with in-center hemodialysis (ICHD). For many patients, home dialysis may also be a more cost-effective option over conventional ICHD treatment.

In July 2019, President Trump signed an executive order called Advancing American Kidney Health (AAKH) that has the goal of promoting home dialysis and increasing kidney transplant, specifically seeking to have 80% of new end stage kidney disease (ESKD) patients either receiving dialysis at home or receiving a transplant by 2025. This is certainly a lofty goal and will “shake up” the future of how the nephrology industry provides care in both the hospital and home sectors.  

Over the past decade or so, approximately 10% of ESKD patients chose and started on a home modality in the United States. Based on the executive order and anticipated changes in patient care and education on ESKD treatments, we will likely start to see a shift and the number of home dialysis patients will grow. As an industry, we need to continue to ensure our nurses and patient care technicians (PCTs) have the training, tools and resources to provide high-quality and safe care for our home patients. Here are a few tips that may help in taking a more seamless integrated care approach in providing home dialysis care:

• Have regular written communication and calls between home program managers and hospital clinical service directors to review trends, establish best demonstrated practices, identify potential gaps in training, and explore avenues for course correction
• Expand current training classes for the hospital team (after obtaining any necessary contracts) to include additional resources and guidance on home dialysis care
• Leverage compliant and clinically appropriate partnerships with vendors to provide supplemental training and support
• Develop HIPAA compliant processes for sharing records when a patient is hospitalized and implement hand-off communication processes to strengthen integrated care model
• Establish and provide urgent start PD programs in collaboration with properly licensed facilities and hospitals that offer this option
• Partner with physicians, case managers and others to ensure patients receive all-modality education on ESKD treatments, including home dialysis and transplant as viable options
• Increase compliant communication in the community on the potential benefits of home dialysis

There are clear benefits to starting, transitioning and maintaining patients on their modality of choice, particularly underutilized modalities like home dialysis. How clinicians can successfully help each patient in doing so is sometimes less clear. Nonetheless, increased collaboration between care providers and team members, along with an integrated model of care, may prove to be keys to home dialysis success.