Nephrologists, patients benefit from accelerating home dialysis education
With the kidney disease community facing a particularly high risk of COVID-19 and becoming hospitalized, a safe transition from in-center hemodialysis to home dialysis is more critical than ever.
Earlier this year, the CMS Learning System for the Comprehensive ESRD Care (CEC) model, in partnership with End-Stage Renal Disease Seamless Care Organizations (ESCOs) nationwide, conducted research to identify best practices for encouraging a safe transition to home dialysis modalities.
To supplement the research, CMS also conducted a case study to assess Fresenius Kidney Care’s home dialysis program.
Fresenius operates 23 of the 36 existing ESCOs across the United States, accounting for 1,000 ESCO dialysis clinics, 1,500 nephrologists and approximately 46,000 patients.1 As a result of numerous educational and operational initiatives to prioritize home-centric modalities, the company saw a 15% increase in home dialysis adoption (from March 1, 2019 to March 1, 2020) and a 40% increase in the overall home hemodialysis population in 2020.
In evaluating the success toward increasing the adoption of home dialysis at Fresenius Kidney Care, CMS determined targeted home dialysis education programs are the most effective solution for encouraging patients to consider the modality.
The findings also yielded the following four strategies to improve home dialysis education, and in turn, patient care:
identify staff who have trusting relationships with patients on in-center hemodialysis (ICHD) to serve as home dialysis educators;
- train staff to discuss the benefits of home dialysis with patients on ICHD;
- develop accessible home dialysis learning activities for patients on ICHD; and
- target education to patients who are likely to clinically benefit from and also consider an in-center-to-home dialysis transition.
These strategies can be broadly characterized as both provider centric and patient centric.
As the rate of home dialysis adoption increases, it is that crucial multidisciplinary care teams are appropriately staffed, educated and comfortable with home modalities to meet the increasing demand.
While Fresenius Kidney Care believes home dialysis, after transplant, is the best treatment option for eligible patients, there is a well-acknowledged lack of familiarity with home dialysis among nephrologists, with 30% to 40% of nephrologists developing substantive practice with home treatment modalities during their fellowship training.1
In response to this gap, Fresenius developed a “Home Champion” program, in which physicians who are identified as being supportive and knowledgeable about home dialysis are engaged to provide education and outreach to other nephrologists.
These home champions also participate in monthly case-based learning sessions, allowing physicians to gain expertise on specific elements of home treatment.
We also recognize that with the uptick in home dialysis, staffing care teams require supplemental providers — including social workers, dietitians, nurses and patient care technicians — to account for nuances in treatment monitoring. Multidisciplinary care teams must receive ample training for monitoring machines, telehealth technology and home dialysis procedures to enable a smooth transition for both provider and patient.
The goals of these education programs are to make providers comfortable with home dialysis, aware of potential complications and ensure the treatment regimen meets the needs of the patients.
Patients who are recently diagnosed with ESRD, and identified as candidates for dialysis, must not only face the reality of a new, frightening diagnosis, but also the overwhelming process of adapting and adhering to a complex, life-sustaining treatment.
To empower patients and instill a sense of control, it is crucial to arm them with resources, education, tools and support so they can make the most informed decision for their treatment.
Fresenius Kidney Care has established more than 100 operating transitional care units (TCUs) around the country. These units are a separate space within a dialysis center that offers more intensive education and hands-on training for patients new to dialysis or those transitioning between treatment modalities.
The TCUs are effective: approximately 45% of all participating patients choose home dialysis after completing the 4- to 6-week program.
In one example, a middle-aged man who had been diagnosed with ESRD and had been living alone had initially rejected home dialysis as an option. Believing the patient was a good candidate for peritoneal dialysis, his physician insisted that the patient go to a TCU before settling on a treatment modality. After 5 weeks of the TCU experience, the patient was educated, emotionally ready and empowered to choose peritoneal dialysis, which also allowed him to continue working.
TCUs provide the opportunity to teach patients when they are receptive to learning the full scope of their treatment options, affording them not only the time to clinically stabilize, but also a moment to address their anxiety and grief with the full support and resources from their coordinated care team.
Beyond in-center education, Fresenius Kidney Care also recognized the importance of providing personalized learning through their formal kidney disease and dialysis education classes called KidneyCare:365 and expanding their patient care staffing model to include the role of kidney care advocates (KCA). As part of the critical care team, KCAs provide individualized patient support by working with the rest of the care team to identify obstacles that patients making treatment transitions might face and provide customized solutions that suit each patient’s situation.
With the help of more than 200 KCAs, Fresenius has educated approximately 57,000 patients with chronic kidney disease or ESRD on home dialysis since the beginning of the program in 2017.
Future of home dialysis
While growth in home dialysis adoption predated the COVID-19 pandemic, the pandemic accelerated operations toward implementing the strategies necessary for successful transition to a home-centric mentality. Looking forward to the future of dialysis treatment, the goal remains the same: to advance knowledge needed to provide home therapy as an option to all patients on dialysis, to educate our clinicians on the basics and to grow home dialysis as aggressively as possible.
- ACO Learning System case study (2020). Fresenius Kidney Care Home Dialysis Program.
- For more information:
- Michelle Carver, BSN, RN, CNN, is the vice president of clinical services initiatives at Fresenius Kidney Care and can be reached at firstname.lastname@example.org.
- Michael Kraus, MD, is associate chief medical officer at Fresenius Kidney Care and can be reached at email@example.com.