Sparking Innovation To Improve the Lives of People with Kidney Disease

Crowley, Susan T.; Meyer, Laurence

doi:10.2215/cjn.04420417

Cited by 5 publications

(9 citation statements)

References 2 publications

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“…Although prior studies focused on decision-making about home dialysis, our study examined challenges and facilitators to the dayto-day implementation of home dialysis. Although expert opinion and stakeholder workshops have underpinned home dialysis recommendations (15)(16)(17), we utilized rigorous qualitative techniques to thematically identify recommendations by participants in home dialysis programs.…”

Section: Discussionmentioning

confidence: 99%

“…Systematic reviews identifying barriers to home dialysis are on the basis of studies of mostly racially/ethnically homogenous, single-centered cohorts outside the United States, which limits generalizability (10)(11)(12)(13)(14). Additionally, current recommendations to increase home dialysis are primarily on the basis of expert opinion and multidisciplinary workshop panels, rather than empirical investigations of stakeholder perspectives (15)(16)(17). Although much research has examined patient decision-making around dialysis modality selection (18)(19)(20)(21), little attention has focused on factors affecting the initiation, daily maintenance, and sustainability of home dialysis.…”

Section: Compared With In-center Hemodialysis (Ic-hd) Home Dialysis (...mentioning

confidence: 99%

“…Similar to non-Veterans, >95% of Veterans with ESKD use IC-HD for maintenance dialysis, whereas <5% use home dialysis (1,17,24). Increasing home dialysis use is a VHA strategic priority (24), with potential to enhance continuity of care to Veterans (17,24), improve access to dialysis care for Veterans in rural areas (25), and reduce dialysis contract costs with non-VHA providers (17,24). In this study, we identify challenges and facilitators to home dialysis implementation and stakeholder-centered recommendations for supporting home dialysis in VA.…”

Section: Introductionmentioning

confidence: 99%

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Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

et al. 2021

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BackgroundHome dialysis confers similar survival and greater quality of life than in-center hemodialysis for adults with ESKD but remains underutilized. We examined challenges and facilitators to implementation of home dialysis and identified stakeholder-centered strategies for improving it.MethodsWe conducted a qualitative, cross-sectional, multisite evaluation that included five geographically dispersed Veterans Health Administration (VHA) home dialysis programs. Participants included patients with ESKD receiving home dialysis, their informal caregivers, and home dialysis staff. Semistructured telephone interviews were conducted and audio-recorded from 2017 through 2018, to assess perceived barriers and facilitators to patient home dialysis use in VHA. Transcribed interviews were analyzed thematically by each participant group.ResultsParticipants included 22 patients receiving home dialysis (18 on peritoneal dialysis [PD] and four hemodialysis [HD]); 20 informal caregivers, and 19 home dialysis program staff. Ten themes emerged as challenges to implementing home dialysis, of which six (60%) spanned all groups: need for sterility, burden of home dialysis tasks, lack of suitable home environment, physical side effects of home dialysis, negative psychosocial effects of home dialysis, and loss of freedom. Four themes (40%), identified only by staff, were insufficient self-efficacy, diminished peer socialization, geographic barriers, and challenging health status. Twelve themes emerged as facilitators to implementing home dialysis, of which seven (58%) spanned all groups: convenience, freedom, avoidance of in-center HD, preservation of autonomy, adequate support, favorable disposition, and perceptions of improved health. Two themes (17%) common among patients and staff were adequate training and resources, and physical and cognitive skills for home dialysis. Recommendations to promote implementation of home dialysis common to all participant groups entailed incorporating mental health care services, offering peer-to-peer coaching, increasing home visits, providing health data feedback, and reducing patient burden.ConclusionsStakeholder-centered challenges were rigorously identified. Facilitators and recommendations can inform efforts to support home dialysis implementation.

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Section: Discussionmentioning

confidence: 99%

Section: Compared With In-center Hemodialysis (Ic-hd) Home Dialysis (...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

et al. 2021

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“…Unfortunately, a limitation of scorecards is the need for the infrastructure for information management. The American Society of Nephrology (ASN) is a leader in the fight against CKD [14]. In February of 2017, the Veteran Association and ASN convened the inaugural Kidney Innovation Summit at the BAH Innovation Center in Washington D.C. to identify opportunities for innovation in the care of people with CKD.…”

Section: Framework and Goals Of Care: Ckd Scorecardsmentioning

confidence: 99%

“…VA principles were applied as a roadmap for kidney innovation, aiming to make care patient-centered, collaborative, data driven, of high value, and continuously improving [15]. Four focus areas for innovation emerged from the Summit: (1) health system initiatives that foster early CKD detection, prevention, and treatment; (2) education and decision aids for people at risk for CKD and their caregivers; (3) data science developments that improve CKD care; and (4) rehabilitation of people with ESRD [14].…”

Section: Framework and Goals Of Care: Ckd Scorecardsmentioning

confidence: 99%

Innovation strategies in CKD prevention and treatment – challenges, opportunities and sharing best practice

Kolesnyk

2019

Ukr. J. Nephrol. and Dial.

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Abstract. Chronic kidney disease (CKD) is a global public health problem, with cardiovascular disease being the major cause of mortality in these patients. CKD is associated with elevated risks of all-cause mortality and other adverse outcomes. This review is highlighting the consistency of the evidence about the hazards that are associated with CKD. The challenge that clinicians now face is to search for CKD, to manage it aggressively, to evaluate novel means of detecting CKD and to expand the therapeutic strategies for patients with CKD. The evidence base for informing effective kidney care is limited, and the translation of existing knowledge to routine clinical care is slow. Innovative approaches are described – patient-oriented care, complex care individualization, early screening for cognitive disorders, anxiety, renal education including education aids & e-Kidney application, teletechnology approach and CKD-self-testing in rural area, novel therapeutic targets for innovative CKD-oriented drugs, etc. Trials with the aim of re-purposing of generic therapeutics should be prioritized if sufficient scientific evidence is available. Furthermore, strategies used to extend patent life of drugs, but without investment to assess re-purposing, should be discouraged. Finally, if the above goals are achieved, new therapies will certainly become available to stop, slow, or reverse CKD. These therapies should be made accessible to populations around the globe.

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Delivering a “New Deal” of Kidney Health Opportunities to Improve Outcomes Within the Veterans Health Administration

Crowley

Murphy

2018

American Journal of Kidney Diseases

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Sparking Innovation To Improve the Lives of People with Kidney Disease

Cited by 5 publications

References 2 publications

Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

Innovation strategies in CKD prevention and treatment – challenges, opportunities and sharing best practice

Delivering a “New Deal” of Kidney Health Opportunities to Improve Outcomes Within the Veterans Health Administration

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