Senior Director, Professional Programs and Member Engagement National Kidney Foundation
Health Care Problem: Insufficient home dialysis education and mentorship are suggested barriers contributing to the under utilization of home therapies in the US. Based on survey data collected from clinicians, patients and care partners, as well as 2 years of workshops and workgroup planning, the National Kidney Foundation (NKF) Home Dialysis task force hypothesized that the use of a Project ECHO (Extension for Community Healthcare Outcome) program may enhance home dialysis uptake. With a limited number of high-performing home dialysis centers and clinical experts in home dialysis in the US, the need for education and mentorship is necessary.
NKF assembled a Hub team made up of physicians, a nurse, social worker, dialysis technician, dietitian, patient, and partnered with a Quality Improvement Organization, Comagine Health, to assess the performance of the dialysis clinics in their ESRD Networks and develop a curriculum that aimed to improve the clinics' ability to get more patients on home dialysis and/or retain them. Clinics were chosen to participate based on their home dialysis uptake/retention rates, and each clinic was provided with their current baseline rate, along with their goal rate based on the Advancing American Kidney Health (AAKH) Executive Order, which provides a target of an 80% increase in patients receiving home therapies by 2025.
Educational Strategy: Project ECHO is a distance health educational model, designed to create virtual communities of learners by bringing together healthcare professionals and subject matter experts, brief lecture presentations, and case-based learning, fostering an “all learn, all teach” approach.
Participants were engaged in a bi-directional virtual knowledge network by sharing clinical challenges and learning from experts and peers. Sessions involved learners taking turns presenting cases from their own clinics, followed by group discussion and recommendations for treatment. Cases submitted and presented by participants included clinician/patient scenarios, care coordination issues, training matters, and access-related complications. By reviewing these cases collaboratively, participants learned how to better manage the clinical and psychosocial issues surrounding home dialysis. Case presentations were then followed by a short educational talk on a subject related to home dialysis (i.e. how to establish a culture of promoting home dialysis; best practice training techniques; patient/family/home assessment; assumptions about barriers; psychosocial adjustment; PD catheter placement; diet; etc.).
Using session evaluations, 88% of learners stated they planned to make changes to their practice, 95% said the activity met the learning objectives, and 99% would recommend ECHO to their peers.
Patient-Level Outcome(s) Measured: In partnership with Comagine Health, the NKF home dialysis ECHO project delivered 20 interprofessional education sessions virtually to 108 registrants from 19 dialysis centers derived from 2 ESRD network regions over 1 year. Using a mixed method before and after approach, we described the differences in home dialysis rate and knowledge utilization.
The median number of participated sessions was 1.5 (range = 16). The registrants represented a diverse background (including: dietitian [n = 15], facility administrator [n = 20], nurse [n=36] and social worker [n=18]). Using exit questionnaires, the registrants consistently recommended ECHO sessions to their peers with the top sessions saturating amongst the themes of “establishing home dialysis culture”, “modality education” and “psychosocial adjustment”.
At baseline, the participating centers’ median home dialysis rate was 9.28% (0.00 – 18.52%) [25-75%] which increased to 12.8% (0.00 – 24.6%) [Wilcoxon Signed Rank Test, p = 0.004] after the program. 73% of participating centers either made some progress or met their AAKH goal after participation in the program.
In conclusion, we demonstrated a home dialysis ECHO program was a feasible strategy that was associated with a modest increase in home dialysis rates. A prospective examination of a national adoption of such a strategy to physicians and dialysis clinic staff is warranted.
