Home before Hospital: a whole of system re-design project to improve rates of home-based dialysis therapy: Experience and outcomes over 8 years
| Autor: | Peter Tregaskis, Scott Wilson, Daniella Chiappetta, Kim Wong, Sandra Macdonald, Kethly Fallon, Susannah Jackson, Fiona Frawley, Rowan G. Walker, Omar Tombocon, Ann Weston, Catherine Reid, Dianne Peart, Robert Flanc, Leanne Palaster |
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| Rok vydání: | 2021 |
| Předmět: |
Quality management
medicine.medical_treatment 030232 urology & nephrology Hemodialysis Home 030204 cardiovascular system & hematology Peritoneal dialysis 03 medical and health sciences 0302 clinical medicine Nursing Renal Dialysis Multidisciplinary approach medicine Humans Dialysis business.industry Health Policy Public Health Environmental and Occupational Health General Medicine Quality Improvement Hospitals Outreach Hemodialysis business Working group Peritoneal Dialysis Patient education |
| Zdroj: | International Journal for Quality in Health Care. 33 |
| ISSN: | 1464-3677 1353-4505 |
| DOI: | 10.1093/intqhc/mzab108 |
| Popis: | Background Despite evidence that clinical outcomes for patients treated with peritoneal dialysis (PD) or home haemodialysis are better than for patients treated with conventional satellite or hospital-based haemodialysis, rates of home-based dialysis therapies world-wide remain low. Home-based dialysis care is also cost-effective and indeed the favoured dialysis option for many patients. Methods & Objectives Using a lean-thinking framework and established change management methodology, a project embracing a system-wide approach at making a change where a ‘Home before Hospital’ philosophy underpinned all approaches to dialysis care was undertaken. Three multidisciplinary working groups (pathway, outreach and hybrid) were established for re-design and implementation. The primary aim was to improve home-based dialysis therapy prevalence rates from a baseline of 14.8% by ≥2.5%/year to meet a target of 35%, whilst not only maintaining but improving the quality of care provided to patients requiring maintenance dialysis. A ‘future’ state pathway was developed after review of the ‘current’ state (Pathway Working Group) and formed the basis on which a nurse-led outreach service (Outreach Working Group) was established. With the support of the multidisciplinary team, the outreach service model focussed on early, consistent, and frequent education, patient support in decision-making, and clinician engagement. Results A target prevalence of >30% for home-based therapies (mainly achieved with PD) was achieved within 2 years. This prevalence rate reached 35% within 3 years and was maintained at 8 years. In addition, selected patients already on maintenance satellite-based haemodialysis (Hybrid Working Group) were educated to achieve high levels of proficiencies in self-care. Conclusion Having the system-wide approach to a Quality Improvement Process and using established principles and change management processes, the successful implementation of a new sustainable model of care focussed on home-based dialysis therapy was achieved. A key feature of the model (through outreach) was early nurse-led education and support of patients in decision-making and ongoing support through multidisciplinary care. |
| Databáze: | OpenAIRE |
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