Renal Research Group, School of Medicine, Keele University, Keele, UK.
Health Services Management Centre, University of Birmingham, Birmingham, UK.
BMJ Open. 2022 Jun 8;12(6):e060922. doi: 10.1136/bmjopen-2022-060922.
Use of home dialysis by centres in the UK varies considerably and is decreasing despite attempts to encourage greater use. Knowing what drives this unwarranted variation requires in-depth understanding of centre cultural and organisational factors and how these relate to quantifiable centre performance, accounting for competing treatment options. This knowledge will be used to identify components of a practical and feasible intervention bundle ensuring this is realistic and cost-effective.
Underpinned by the non-adoption, abandonment, scale-up, spread and sustainability framework, our research will use an exploratory sequential mixed-methods approach. Insights from multisited focused team ethnographic and qualitative research at four case study sites will inform development of a national survey of 52 centres. Survey results, linked to patient-level data from the UK Renal Registry, will populate a causal graph describing patient and centre-level factors, leading to uptake of home dialysis and multistate models incorporating patient-level treatment modality history and mortality. This will inform a contemporary economic evaluation of modality cost-effectiveness that will quantify how modification of factors facilitating home dialysis, identified from the ethnography and survey, might yield the greatest improvements in costs, quality of life and numbers on home therapies. Selected from these factors, using the capability, opportunity and motivation for behaviour change framework (COM-B) for intervention design, the optimal intervention bundle will be developed through workshops with patients and healthcare professionals to ensure acceptability and feasibility. Patient and public engagement and involvement is embedded throughout the project.
Ethics approval has been granted by the Health Research Authority reference 20-WA-0249. The intervention bundle will comprise components for all stake holder groups: commissioners, provider units, recipients of dialysis, their caregivers and families. To reache all these groups, a variety of knowledge exchange methods will be used: short guides, infographics, case studies, National Institute for Health and Care Excellence guidelines, patient conferences, 'Getting it Right First Time' initiative, Clinical Reference Group (dialysis).
英国各中心的家庭透析使用情况差异很大，尽管试图鼓励更多使用，但仍在减少。要了解是什么导致了这种不必要的变化，需要深入了解中心的文化和组织因素，以及这些因素如何与可量化的中心绩效相关，同时考虑到竞争治疗方案。这方面的知识将用于确定一套实用且可行的干预措施，以确保其具有现实性和成本效益。
在非采用、放弃、扩大、推广和可持续性框架的基础上，我们的研究将采用探索性序贯混合方法。来自四个案例研究地点的多地点聚焦团队民族志和定性研究的见解将为对 52 个中心进行的全国调查提供信息。调查结果将与英国肾脏注册处的患者水平数据相关联，以填充描述患者和中心水平因素的因果图，这些因素导致家庭透析的采用以及多状态模型，其中包括患者水平的治疗模式历史和死亡率。这将为模式成本效益的当代经济评估提供信息，该评估将量化通过民族志和调查确定的促进家庭透析的因素的修改如何在成本、生活质量和家庭治疗人数方面产生最大的改善。使用行为改变的能力、机会和动机框架（COM-B）选择这些因素中的一部分，用于干预设计，将通过与患者和医疗保健专业人员的研讨会来开发最佳的干预措施，以确保可接受性和可行性。整个项目都嵌入了患者和公众的参与和投入。
健康研究管理局已批准该项目，注册号为 20-WA-0249。干预措施将包括为所有利益相关者群体制定组成部分：委员会、提供者单位、透析接受者、他们的护理人员和家庭。为了覆盖所有这些群体，将使用各种知识交流方法：简短指南、信息图表、案例研究、国家卫生与保健卓越研究所指南、患者会议、“首次就做正确”倡议、临床参考小组（透析）。
