IPRO ESRD Networks are tasked by the Centers for Medicare and Medicaid Services (CMS) to work with facilities to increase the use home therapies.
Home dialysis modalities are underutilized in the USA with only 8% of the dialysis patients undergoing renal replacement therapy at home versus 92% being treated with center hemodialysis.
As a result, the following AIM with a 5-year target has been set to guide national health promotion and management to improve the health of all people in the United States living with ESRD: by 2023, to increase the number of ESRD patients dialyzing at home to 16% from the 2016 national average of 12%. (The 2016 NY State average was 6%)
The intent of the Home Dialysis QIA is to promote referral to home dialysis modalities, identify and mitigate the barriers to timely referral, and determine the steps patients and providers can take to improve referral patterns. The Networks shall increase the number of patients on a home modality by participating in the ESRD NCC Home Dialysis LAN, and assisting dialysis facilities in the implementation of interventions to support patients through the process of training to dialyze at home.
 Thinking outside the box—identifying patients for home dialysis; written by: Brigitte Schiller, Hayley Munroe, and Andrea Neitzer
Goal: 10 percentage point increase in home therapies training over baseline.
Timeline: Facilities are selected and notified of their participation in January. The Network will work with the facilities to implement interventions. Facilities will be notified in October if they have met the goal to graduate or will continue in the project during the next year. Facilities not meeting goal should continue to implement interventions and strategies regardless of the measurement period to maximize their ability to graduate in future years.
Facility Selection: 30% of all Network Service area chronic out patients dialysis facilities that treat in-center hemodialysis pateints. (stand alone home therapy facilities are excluded)
Baseline Data: The QIA baseline data was provided by the ESRD National Coordinating Center (NCC) from the facility submitted information available in CROWNWeb.
Re-Measurement Data: Data for this QIA will be extracted from facility monthly CROWNWeb data, and will be provided to the Network by the ESRD National Coordinating Center (NCC.)
Tools and Resources
January Baseline Data Collection Tool PDF Worksheet; Online Submission Form
RCA 5 Whys Tutorial Worksheet, Recording; Slides; Evaluation Form
February 2018 Network Calendar Printable PDF
Institute for Healthcare Improvement (IHI) Resources
IHI Paper: Going Lean in Healthcare
IHI Video Activity: A comparison LEAN and QI
AHRQ Shared Decision Making Resources
The Agency for Healthcare Research and Quality's (AHRQ) SHARE Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each option through meaningful dialogue about what matters most to the patient. FACT Sheet PDF Flyer
The Agency provides a collection of tools and training resources to support the implementation of shared decision making in practice. Refer to www.ahrq.gov/shareddecisionmaking to locate resources such as:
SHARE Approach Workshop Curriculum: Collection of training guides, slides, videos, and other resources to support the training of health care professionals on shared decision making and SHARE Approach implementation
SHARE Approach Tools: Collection of reference guides, posters, and other resources designed to support AHRQ’s SHARE Approach implementation
SHARE Approach Webinars: Accredited webinars that review topics related to the implementation of patient-centered outcomes research in shared decision making
SHARE Approach Success Stories: AHRQ’s SHARE Approach tools and resources are used by organizations nationwide to implement shared decision making in health care. These case studies highlight stories of successes and best practices by describing the use and impact of the AHRQ’s SHARE Approach strategies and tools by health systems, clinicians, academicians, and other professionals.