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

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.