Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Renal Research Group, School of Medicine, Keele University, Keele, UK.
Perit Dial Int. 2024 Jul;44(4):265-274. doi: 10.1177/08968608241232200. Epub 2024 Mar 6.
Disparities in home dialysis uptake across England suggest inequity and unexplained variation in access. We surveyed staff at all English kidney centres to identify patterns in service organisation/delivery and explore correlations with home therapy uptake, as part of a larger study ('Inter-CEPt'), which aims to identify potentially modifiable factors to address observed variations.
Between June and September 2022, staff working at English kidney centres were surveyed and individual responses combined into one centre-level response per question using predetermined data aggregation rules. Descriptive analysis described centre practices and their correlation with home dialysis uptake (proportion of new home dialysis starters) using 2019 UK Renal Registry 12-month home dialysis incidence data.
In total, 180 responses were received (50/51 centres, 98.0%). Despite varied organisation of home dialysis services, most components of service delivery and practice had minimal or weak correlations with home dialysis uptake apart from offering assisted peritoneal dialysis and 'promoting flexible decision-making about dialysis modality'. Moderate to strong correlations were identified between home dialysis uptake and centres reporting supportive clinical leadership (correlation 0.32, 95% Confidence Interval (CI): 0.05-0.55), an organisational culture that values trying new initiatives (0.57, 95% CI: 0.34-0.73); support for reflective practice (0.38, 95% CI: 0.11-0.60), facilitating research engagement (0.39, 95% CI: 0.13-0.61) and promoting continuous quality improvement (0.29, 95% CI: 0.01-0.53).
Uptake of home dialysis is likely to be driven by organisational culture, leadership and staff attitudes, which provide a supportive clinical environment within which specific components of service organisation and delivery can be effective.
英格兰地区居家透析的接受程度存在差异，这表明在获得治疗的机会方面存在不公平和无法解释的差异。我们调查了所有英国肾脏中心的工作人员，以确定服务组织/提供模式，并探索与居家治疗接受程度的相关性，这是一项更大规模的研究（“Inter-CEPt”）的一部分，该研究旨在确定潜在的可改变因素，以解决观察到的差异。
2022 年 6 月至 9 月期间，对英国肾脏中心的工作人员进行了调查，并使用预先确定的数据汇总规则，将个人的回答合并为每个问题的一个中心级别的回答。使用 2019 年英国肾脏登记处的 12 个月居家透析发病率数据，对描述性分析描述的中心实践及其与居家透析接受率（新开始居家透析患者的比例）的相关性进行了描述。
共收到 180 份回复（51 个中心中的 50 个，98.0%）。尽管居家透析服务的组织形式各不相同，但除了提供辅助性腹膜透析和“促进关于透析模式的灵活决策”外，服务提供和实践的大部分组成部分与居家透析接受率的相关性很小或很弱。中心报告的支持性临床领导力（相关性 0.32，95%置信区间[CI]：0.05-0.55）、重视尝试新举措的组织文化（0.57，95%CI：0.34-0.73）、支持反思性实践（0.38，95%CI：0.11-0.60）、促进研究参与（0.39，95%CI：0.13-0.61）和促进持续质量改进（0.29，95%CI：0.01-0.53）之间存在中度到高度的相关性。
居家透析的接受程度可能由组织文化、领导力和员工态度驱动，这些因素为提供了一个支持性的临床环境，在此环境中，服务组织和提供的具体组成部分可以发挥作用。
