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- A newly developed tool assesses patients’ home dialysis experience.
- The 26-item Home Dialysis Care Experience instrument will be a resource for future research use, clinical care, and quality improvement initiatives among home dialysis facilities and organizations.
Home dialysis, which includes both peritoneal dialysis and home hemodialysis, allows patients to receive their dialysis treatments at home, gives patients independence and flexibility with their treatment schedules, and is associated with similar or better outcomes and lower costs compared with conventional in-center hemodialysis. Home dialysis modalities are the fastest growing types of dialysis treatments in the United States, and this trend is likely to continue as recent policies provide incentives to dialysis providers and kidney specialists to promote home dialysis.
Matthew Rivara, MD (Kidney Research Institute, University of Washington) and his colleagues recently developed a tool to assess patients’ opinions concerning their home dialysis care. “Assessing patients’ experience of their home dialysis care is incredibly important to make sure that quality improvement efforts in home dialysis focus on areas that patients—not just doctors—consider important,” said Dr. Rivara.
The investigators conducted a literature review to identify domains of home dialysis care that could be important to address, and then they interviewed home dialysis patients, home dialysis nurses, patient care partners, and kidney specialists. This was followed by a national stakeholder survey to prioritize important elements of care. These efforts allowed the team to design a new survey tool to best capture the home dialysis care experience. The tool is called the Home Dialysis Care Experience (Home-DCE) instrument, a 26-item patient-reported experience measure.
“One important observation that we made in reviewing the results of our work was the central importance that all stakeholders—patients, care partners, doctors, and nurses—placed on good consistent communication and care coordination. This was universally felt to be of greater importance in evaluating high quality home dialysis care from the patient’s perspective compared with other aspects of care such as facility cleanliness, timeliness of laboratory results and appointments, and a number of other factors,” said Dr. Rivara. “Another important finding was the consistency of our findings no matter who we spoke to. In general, patients, care partners, nurses, and doctors all noted similar elements of home dialysis care that were the most important.”
The Home-DCE tool will be a valuable resource for research, clinical care, and quality improvement initiatives among home dialysis facilities and organizations.
An accompanying editorial notes that “this laudatory work meets an important need for quality measurement tools in home dialysis, and comes at a moment when two decades of federal policies incentivizing patient-centered care and promoting home dialysis intersect.”
A Patient Voice article also accompanies the study.
Study co-authors include Todd Edwards, PhD; Donald Patrick, PhD; Lisa Anderson, BA; Jonathan Himmelfarb MD; and Rajnish Mehrotra, MD, MS.
Disclosures: Funding for the study was provided by Satellite Healthcare, a not-for-profit kidney care provider. Dr. Mehrotra is the editor-in-chief of CJASN. He was not involved in the review of or any decisions regarding the manuscript. He has received honoraria from Baxter Healthcare. Dr Himmelfarb is a founder and holds equity in AKTIV-X Technologies, Inc, which is developing novel forms of portable hemodialysis suitable for home use. The remaining authors report no conflicts of interest.
The article, titled “Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis,” will appear online at http://cjasn.asnjournals.org/ on March 30, 2021, doi: 10.2215/CJN.15570920.
The editorial, titled “Measuring Patient Experience with Home Dialysis in the United States,” will appear online at http://cjasn.asnjournals.org/ on March 30, 2021, doi: 10.2215/CJN.01990221.
The Patient Voice editorial, titled “Patient Experiences with Home Dialysis,” will appear online at http://cjasn.asnjournals.org/ on March 30, 2021, doi: 10.2215/CJN.01570221.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 21,000 members representing 131 countries. For more information, visit www.asn-online.org.
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