Dialysis Modality Education Timing and Home Dialysis Uptake: A Quality Improvement Study

IF 3.2 Q1 UROLOGY & NEPHROLOGY
Declan (Shiyu) Lu , Mishal Akhtar , Lisa Dubrofsky , Bourne L. Auguste
{"title":"Dialysis Modality Education Timing and Home Dialysis Uptake: A Quality Improvement Study","authors":"Declan (Shiyu) Lu ,&nbsp;Mishal Akhtar ,&nbsp;Lisa Dubrofsky ,&nbsp;Bourne L. Auguste","doi":"10.1016/j.xkme.2024.100898","DOIUrl":null,"url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Investigating the effect of a quality improvement intervention aimed at enhancing the choice of home dialysis among patients through improved educational sessions on dialysis modalities.</div></div><div><h3>Study Design</h3><div>A new referral protocol initiated on September 15, 2022, sought to direct patients with advanced kidney disease to modality education sessions. This protocol involved an updated referral form and process, requiring nephrologists to refer patients with an estimated glomerular filtration rate below 15<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or specified Kidney Failure Risk Equation scores to modality educators for education. The impact was measured by the uptake of the education and the choice of home dialysis by patients.</div></div><div><h3>Setting &amp; Participants</h3><div>The study took place at Sunnybrook Health Sciences Centre in Toronto, Canada, involving 532 patients across 1,723 clinical encounters from October 2019 to June 2023.</div></div><div><h3>Predictor</h3><div>The intervention was predicted to lead to an increase in both the number of patients receiving modality education and those choosing home dialysis.</div></div><div><h3>Outcomes</h3><div>The primary outcome measured was the selection of home dialysis following modality education, with a secondary focus on the proportion of patients educated post intervention.</div></div><div><h3>Analytical Approach</h3><div>Statistical process charts were used for monitoring changes in education uptake and home dialysis selection rates following the intervention.</div></div><div><h3>Results</h3><div>After implementing the standardized referral system, the proportion of patients receiving modality education increased from 27.1%-56.7%. However, the rate of selecting home dialysis remained constant at 50.9%. Overall home dialysis prevalence at our center averaged 19.6%, remaining lower than the provincial average of 24.4% by the end of the study period.</div></div><div><h3>Limitations</h3><div>The study was limited to 1 center, without evaluating patient satisfaction or dissecting the complexity of educational content and delivery.</div></div><div><h3>Conclusions</h3><div>We succeeded in boosting education rates but failed to achieve higher home dialysis choice rates, possibly owing to the complexity involved in modality choices. We plan to further investigate the factors influencing patient choices during modality education to better promote home dialysis selection.</div></div><div><h3>Plain-Language Summary</h3><div>The study focused on whether teaching patients more about their dialysis options would encourage them to choose home dialysis. A new system was introduced at an academic hospital in Toronto, requiring doctors to refer patients with advanced kidney disease to educational sessions. The aim was to see if patients who learned more about dialysis would be more likely to manage their treatment at home. The result was more patients received these educational sessions, but this did not lead to more of them choosing home dialysis. Future research must investigate what other factors influence patients’ decisions to consider dialysis treatments at home.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590059524001092","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Rationale & Objective

Investigating the effect of a quality improvement intervention aimed at enhancing the choice of home dialysis among patients through improved educational sessions on dialysis modalities.

Study Design

A new referral protocol initiated on September 15, 2022, sought to direct patients with advanced kidney disease to modality education sessions. This protocol involved an updated referral form and process, requiring nephrologists to refer patients with an estimated glomerular filtration rate below 15 mL/min/1.73 m2 or specified Kidney Failure Risk Equation scores to modality educators for education. The impact was measured by the uptake of the education and the choice of home dialysis by patients.

Setting & Participants

The study took place at Sunnybrook Health Sciences Centre in Toronto, Canada, involving 532 patients across 1,723 clinical encounters from October 2019 to June 2023.

Predictor

The intervention was predicted to lead to an increase in both the number of patients receiving modality education and those choosing home dialysis.

Outcomes

The primary outcome measured was the selection of home dialysis following modality education, with a secondary focus on the proportion of patients educated post intervention.

Analytical Approach

Statistical process charts were used for monitoring changes in education uptake and home dialysis selection rates following the intervention.

Results

After implementing the standardized referral system, the proportion of patients receiving modality education increased from 27.1%-56.7%. However, the rate of selecting home dialysis remained constant at 50.9%. Overall home dialysis prevalence at our center averaged 19.6%, remaining lower than the provincial average of 24.4% by the end of the study period.

Limitations

The study was limited to 1 center, without evaluating patient satisfaction or dissecting the complexity of educational content and delivery.

Conclusions

We succeeded in boosting education rates but failed to achieve higher home dialysis choice rates, possibly owing to the complexity involved in modality choices. We plan to further investigate the factors influencing patient choices during modality education to better promote home dialysis selection.

Plain-Language Summary

The study focused on whether teaching patients more about their dialysis options would encourage them to choose home dialysis. A new system was introduced at an academic hospital in Toronto, requiring doctors to refer patients with advanced kidney disease to educational sessions. The aim was to see if patients who learned more about dialysis would be more likely to manage their treatment at home. The result was more patients received these educational sessions, but this did not lead to more of them choosing home dialysis. Future research must investigate what other factors influence patients’ decisions to consider dialysis treatments at home.
透析方式教育时机与家庭透析使用率:质量改进研究
研究设计2022年9月15日启动的新转诊协议旨在引导晚期肾病患者参加透析方式教育课程。该方案包括更新转诊表格和流程,要求肾科医生将估计肾小球滤过率低于 15 mL/min/1.73 m2 或特定肾衰竭风险方程评分的患者转诊至透析方式教育者接受教育。该研究在加拿大多伦多桑尼布鲁克健康科学中心进行,从2019年10月至2023年6月,共涉及1723例临床就诊的532名患者。预测该干预措施将导致接受方式教育和选择家庭透析的患者人数增加。结果测量的主要结果是接受方式教育后选择家庭透析的患者人数,其次是干预后接受教育的患者比例。分析方法使用统计过程图监测干预后教育接受率和家庭透析选择率的变化。但是,选择家庭透析的比例仍保持在 50.9%。结论我们成功地提高了教育率,但未能实现更高的家庭透析选择率,这可能是由于透析方式选择的复杂性。我们计划进一步研究影响患者在透析方式教育过程中做出选择的因素,以更好地促进患者选择家庭透析。多伦多一家学术医院引入了一个新系统,要求医生推荐晚期肾病患者参加教育课程。这样做的目的是为了了解患者在了解了更多透析知识后,是否更愿意在家接受治疗。结果是更多的病人接受了这些教育课程,但这并没有导致更多的病人选择在家透析。未来的研究必须调查还有哪些因素会影响患者考虑在家透析治疗的决定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Kidney Medicine
Kidney Medicine Medicine-Internal Medicine
CiteScore
4.80
自引率
5.10%
发文量
176
审稿时长
12 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信