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Damery S, Lambie M, Williams I, Coyle D, Fotheringham J, Solis-Trapala I, Allen K, Potts J, Dikomitis L, Davies SJ. Centre variation in home dialysis uptake: A survey of kidney centre practice in relation to home dialysis organisation and delivery in England. Perit Dial Int 2024; 44:265-274. [PMID: 38445495 DOI: 10.1177/08968608241232200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Lambie
- Renal Research Group, School of Medicine, Keele University, Keele, UK
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - David Coyle
- NIHR Devices for Dignity, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James Fotheringham
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jessica Potts
- Renal Research Group, School of Medicine, Keele University, Keele, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent, Canterbury, UK
| | - Simon J Davies
- Renal Research Group, School of Medicine, Keele University, Keele, UK
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Rivara MB, Prince DK, Leuther KK, Hussein WF, Mehrotra R, Edwards T, Schiller B, Patrick DL. Evaluation and Measurement Properties of a Patient-Reported Experience Measure for Home Dialysis. Clin J Am Soc Nephrol 2024; 19:602-609. [PMID: 38261328 PMCID: PMC11108240 DOI: 10.2215/cjn.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND No previously validated patient-reported experience measures exist for use among patients undergoing home dialysis. We tested the Home Dialysis Care Experience survey, a newly developed 26-item experience measure, among patients from 30 dialysis facilities in the United States. METHODS Using mail and telephone survey modalities, we approached 1372 patients treated with peritoneal dialysis or home hemodialysis for participation. Using the results from completed surveys, we evaluated item calibration by assessing item floor and ceiling effects. We tested three sets of composite scores and used factor analysis to assess model fit for each. We evaluated associations of composite scores with global ratings and separately with patient and dialysis facility characteristics. Finally, we measured test-retest reliability in patients who completed the survey at two separate time points. RESULTS Overall, 495 eligible patients completed at least one survey (response rate 36%). Of these, 49 completed the survey in Spanish and 61 completed a second survey within 30 days. We did not detect significant floor or ceiling effects, except for one item that demonstrated >90% responses at the top response option. Analyses supported one 12-item composite scale with high internal consistency reliability: Quality of Home Dialysis Care and Operations (Cronbach alpha=0.85). This scale strongly correlated with overall staff rating ( r =0.73) and overall center rating ( r =0.70). Patient demographic and dialysis facility characteristics were not consistently associated with composite scale scores or overall staff or center ratings. Intraclass correlation coefficients in the test-retest population were 0.74 for the Quality scale, 0.88 for overall staff rating, and 0.90 for overall center rating. CONCLUSIONS The Home Dialysis Care Experience survey is a 26-item measure that includes one composite scale and two global rating scores and is an informative tool to evaluate patient experience of care for home dialysis.
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Affiliation(s)
- Matthew B. Rivara
- Kidney Research Institute, University of Washington, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - David K. Prince
- Kidney Research Institute, University of Washington, Seattle, Washington
| | | | - Wael F. Hussein
- Satellite Healthcare, Inc. San Jose, California
- Stanford University Department of Medicine, Palo Alto, California
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, Seattle, Washington
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Todd Edwards
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| | - Brigitte Schiller
- Satellite Healthcare, Inc. San Jose, California
- Stanford University Department of Medicine, Palo Alto, California
| | - Donald L. Patrick
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
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Mendu ML, Divino-Filho JC, Vanholder R, Mitra S, Davies SJ, Jha V, Damron KC, Gallego D, Seger M. Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable. Kidney Med 2021; 3:635-643. [PMID: 34401729 PMCID: PMC8350829 DOI: 10.1016/j.xkme.2021.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In a groundbreaking meeting, leading global kidney disease organizations came together in the fall of 2020 as an International Home Dialysis Roundtable (IHDR) to address strategies to increase access to and uptake of home dialysis, both peritoneal dialysis and home hemodialysis. This challenge has become urgent in the wake of the coronavirus disease 2019 (COVID-19) pandemic, during which patients with advanced kidney disease, who are more susceptible to viral infections and severe complications, must be able to safely physically distance at home. To boost access to home dialysis on a global scale, IHDR members committed to collaborate, through the COVID-19 public health emergency and beyond, to promote uptake of home dialysis on a broad scale. Their commitments included increasing the reach and influence of key stakeholders with policy makers, building a cooperative of advocates and champions for home dialysis, working together to increase patient engagement and empowerment, and sharing intelligence about policy, education, and other programs so that such efforts can be operationalized globally. In the spirit of international cooperation, IHDR members agreed to document, amplify, and replicate established efforts shown to improve access to home dialysis and support new policies that facilitate access through procedures, innovation, and reimbursement.
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Affiliation(s)
- Mallika L. Mendu
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of the Chief Medical Officer, Brigham and Women’s Hospital, Boston, MA
| | - José Carolino Divino-Filho
- Division of Renal Medicine, CLINTEC, Karolinska Institute, Campus Flemingsberg, Stockholm, Sweden
- Latin America Chapter (LAC-DD)-International Society for Peritoneal Dialysis
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent
- European Kidney Health Alliance (EKHA), Brussels, Belgium
| | - Sandip Mitra
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- National Institute of Health Research MedTech and In-vitro Diagnostics Co-operative, Devices for Dignity, Sheffield
| | - Simon J. Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - International Home Dialysis Roundtable Steering Committee
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of the Chief Medical Officer, Brigham and Women’s Hospital, Boston, MA
- Division of Renal Medicine, CLINTEC, Karolinska Institute, Campus Flemingsberg, Stockholm, Sweden
- Latin America Chapter (LAC-DD)-International Society for Peritoneal Dialysis
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent
- European Kidney Health Alliance (EKHA), Brussels, Belgium
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- National Institute of Health Research MedTech and In-vitro Diagnostics Co-operative, Devices for Dignity, Sheffield
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- National Kidney Foundation, New York, NY
- European Kidney Patients Federation, Vienna, Austria
- Venn Strategies, Washington, DC
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