Predictors of Care Gaps in Home Dialysis: The Home Dialysis Virtual Ward Study

Abstract

Background: Home dialysis patients may be at an increased risk of adverse events after transitional states. The home dialysis virtual ward (HDVW) trial was conducted in Canadian dialysis centers and aimed to evaluate potential care gaps and patient satisfaction during the HDVW. Methods: The HDVW was a multicenter single-arm trial including peritoneal dialysis and home hemodialysis patients after 4 different events (hospital discharge, medical procedure, antibiotics, completion of training). Telephone-led interviews using a standardized assessment tool were performed over a 2-week period to assess a patient’s care and adjust treatment as required. Upon completion, patients were surveyed to evaluate their perceived impact on domains of care using a rating scale; 1 not satisfied to 10 completely satisfied. Results: The HDVW trial included 193 patients with a median number of potential care gaps/interventions of 1 (0–2) per patient. Patients admitted to the HDVW after hospital discharge were at a higher risk of potential gaps in care (OR 2.16, 95% CI 1.29–3.62), while longer dialysis vintage was ­associated with a lower number of gaps/interventions (OR 0.97 per year, 95% CI 0.95–0.98). A total of 105/193 (54%) patients completed satisfaction surveys. Patients were highly satisfied with the HDVW (median rating scale score 8, IQR 2) and felt it had a positive impact (rating scale score ≥7) on their overall health, understanding of treatment and access to a nephrologist. Conclusion: The HDVW was effective at identifying several potential care gaps, and patients were satisfied across several domains of care. This intervention may be valuable in supporting home dialysis patients during care transitions.

Exploring stakeholders and their requirements in the process of home hemodialysis: A literature review

“…Furthermore, 34 quantitative studies were considered for assessment (see Table S3). From the excluded 12 studies, ten 35–44 were not fully accessible and one study was based on simulation 45 and one on component analysis 46 . The four mix‐method studies 47–50 were assessed based on both qualitative and quantitative criteria.…”

Understanding Home Hemodialysis Patient Attrition: A Cohort Study

“…Examples of a reduced program ask could include the following: reduced frequency of blood work, outsourcing the dialysate and water sampling to technicians, reducing the number of in-person clinic visits in favor of virtual medicine, and reducing the frequency of audit requirements. Regular bi-annual vascular access audits in conjunction with re-training for patients at risk are important interventions that can reduce patient error 26,27 and hopefully lead to a decrease in technique failure.…”

Risk of hospitalization, technique failure, and death with increased training duration in 3‐days‐a‐week home hemodialysis

“…The HDVW study also found that potential gaps in care were frequently encountered after transitional events in home dialysis patients, such as after start of home dialysis. 20 Such follow-up tools might help to reduce fear of isolation, a frequently named limitation for HHD 21 while minimizing the likelihood of adverse events. To reduce the need for home follow-up visits, simulation initiatives have also been studied.…”