Home Dialysis RA 2017
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Transcript of Home Dialysis RA 2017
Home DialysisImprovement project
Why?
• Home dialysis• Includes PD and HD
• Includes self and assisted care models
• Benefits• Personal
• Medical
• Quality of life
• System• Resources
Guidance
• Professional guidance• NICE
• 2002 https://www.nice.org.uk/guidance/ta48
• Renal Association• Peritoneal Dialysis in Adults and
Children June 2017
• Research evidence
• Patient organisations
Attitudes positive in the main …..
BMC Nephrol. 2014 Jan 15;15:16. doi: 10.1186/1471-2369-15-16.
…… but disconnect with delivery
UK Renal Registry 18th Annual Report
Variation across UK is high
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Carsh L Barts L Guys L Kings L Rfree L St.G L West
Data taken from UK Renal Registry % prevalent patients on home dialysis modality
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Progress is slow (or stagnant) Fall in PD > growth in HHD
UK Renal Registry 18th Annual Report
Why?
• 185 respondents • 50% at meeting
• MDT mix (30% medic, 35% nurse)
• Resources – red
• Patient factors – dark blue
• Service factors – light blue
All respondents Low leadership barrier
Responses
Answer Options Rating Average (all) Rating Average Low leadership barrier
Reimbursement for home dialysis (i.e. what centres get paid) 2.21 2.00
Equipment, consumables and installation cost 2.42 2.22
Patient housing unsuitable 2.91 2.82
Patient and carers choice or desire 2.82 2.63
Patient frailty or illness 3.14 3.04
Staff knowledge and confidence 2.40 2.10
The in centre HD unit referral rate 2.57 2.21
Pre dialysis team referral rate 2.21 1.92
Business planning or management support 2.70 2.32
Champions or leaders for home therapies 2.25 1.52
Bias from clinical teams 2.48 2.07
Resources for training of patients and carers 2.60 2.33
Patient knowledge and confidence 2.80 2.60
Resources to support people at home 2.72 2.48
Why?
• Financial concerns were not the main barriers.
• Strong leadership and a positive organisational culture were the main contributors towards successful home dialysis programmes.
• Change management skills to deliver sustainable, systematic and evidenced change are needed.
• Patient factors – frailty, choice – were important determinants, but less so in some leadership systems.
Manchester Home Dialysis Forum 2016 Workshops
To increase the proportion of patients on home dialysis therapies in England
Clear Vision & Purpose
Leadership
i) Organisational ii) Medical iii) Nursing iv) Patient Leadership
Organisational Culture
Values, behaviours & mindset
Expertise [Knowledge& skills]
Patients
Determining ‘suitable’ home dialysis patients
Develop patient exclusion criteria, dependent on local expertise
Home dialysis training
Effectiveness & experience of training pathway
Patient awareness, recruitment & retention
Patient Education & Informed Choice; Patient & carer experience;
Peer support; Carer support
Organisational Infrastructure
Financial support
Training facilities
Commissioning dialysis consumables and machines
Home modifications
Access to respite care
Multidisciplinary team supported by community team
DRIVER DIAGRAM: Home Dialysis
The KQuIP proposal
• A national improvement project
• Based upon regional collaboratives or networks
• Central support from KQuIP
• Coproduction
Perception of suitability
X
System efficacy
=
Probability of home dialysis
Leadership
Skills, knowledge and confidence
Culture
Measurement
How?
• Our Shared Vision
• To reduce regional variation and improve delivery of home dialysis in order to
• Improve the experience of care of individual patients and their families
• Improve the value of care by improving outcomes at the same or reduced cost.
• Sponsored by national stakeholders
• Operational support from UKRR KQuIP team
• Regional networks supported by project management time
• Regions to establish regional teams and provider teams to lead work – MDT & service user integrated
Three phases to improvement at network level• Step 1: Research and discovery
• What works well, regionally or nationally?
• What can you use or adapt?
• How will you measure success?
• Step 2: Ideas
• Develop long list of ideas
• Refine list by discussion
• Agree final list
• Step 3:
• Test ideas• Agnostic to QI methodology• Embrace uncertainty • Collect evidence
• Present and refine (or abandon)
• Repeat cycle
Start PD pathway
Plan dialysis access - insert PD catheter
Patient and MDT sign off for PD pathway
Assess for suitability– clinical, patient factors and home suitability
Screen low clearance, Prevalent HD, Incident HD, Failed Tx
Identify potential PD patients through shared decision making
MDT review
Next steps
• Funding
• Project plan
• Steering committee established
• Define data set• Clinical• Patient – PAM, PREM, PROM• Process measures• Balancing measures
• Network applications
• Launch for project initiation Sept 2017
• Project start (network 1) April 2018