Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.
Kidney360. 2020 May 1;1(6):569-579. doi: 10.34067/KID.0000662019. eCollection 2020 Jun 25.
Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.
尽管各种透析模式的总体生存率相似，而且最近有扩大这些模式的激励措施，但家庭透析模式在美国的使用率仍然明显较低。尽管使用家庭透析模式的患者绝对数量有所增加，但与中心血液透析（ICHD）相比，其比例仍然相当低。家庭透析利用的已知障碍存在，需要采取有组织的团队方法来克服这些障碍。在此，我们描述了在一家大型学术医疗中心扩大家庭透析项目的努力，过去 9 年来，家庭透析患者的比例从 12%增长到 21%。我们优先考虑为患者提供个性化教育，并为医生提供更好的培训，借助现有资源，旨在更好地利用家庭透析模式；例如，每月两次由经验丰富的执业护士教授专门的透析教育课程，以及利用透析提供者的透析教育工作者对患有 CKD 的患者进行住院教育。肾脏病学研究员课程进行了结构调整，重点关注家庭透析模式，并鼓励参加年度家庭透析会议。为了及时进行透析通路的安置和故障排除，我们遵循了一种互补的团队方法，使用外科医生和介入放射科医生以及肾脏病医生，由 UAB 制定的标准化方案驱动，并由我们的通路协调员共同管理。采用团队方法，强调透析护士的员工参与和领导机会，以及来自一组临床肾脏病医生和透析提供者的协作努力，有助于维持效率、促进增长，并在家疗计划中提供始终如一的高质量临床护理。最后，努力减轻疾病负担，例如减少每月就诊次数，并使用创新策略，如远程肾脏病学和辅助 PD 和 HHD，有助于减少流失。
