Promote Appropriate Home Therapies
Quality Improvement Activity (HT QIA)
For questions or technical assistance, please contact:
Anna Bennett
Quality Improvement Coordinator
(516) 209-5474

Jeanine Pilgrim
Quality Improvement Director
(516) 209-5365  
QIA Facilities:

List of Facilities 

included in the Promote Appropriate Home Dialysis QIA

Share: the CROWNWeb HT Data Entry Tip Sheet with your staff to ensure that data is being properly reported.

Attend: 6/12/2018  ESRD NCC Home Therapies LAN Webinar

DISCUSS Rapid Cycle Improvement: Speak with your staff, patients and administration about any changes that you have made/need to make to your Treatment Options Education Process.  Report any Rapid Cycle Improvements implemented on this month's reporting form.  

Report:  Due 6/30
Feedback, Barriers, Successes, and (if non LDO) Step Data.
Best Practices
Home Therapy (HT) Sustainability Reported in May: (Is this happening/possible
at your dialysis facility?)
" We have a designated staff member responsible for educating the patients during their 30-60-90 days after admission in addition to unit staff support for education." 
June 2018 Updates

TO: All HT QIA Facility Staff, Patient SMEs and Stakeholders

June is time for our six month check up!  Get ready to take a deep dive into your facility practices when it comes to patient education.
  • During this QIA, has your facility utilized any Rapid Cycle Improvement in your process for educating patients, care partners and family members about Home Therapies?
  • Does your facility have a Treatment Options Education Station?
  • Can EACH of your in center dialysis patients articulate WHY they are not/don't want to be using home therapies?
New Activity/Resources:

Patient Interview Worksheet
Did you know that the first question a State Surveyor asks in the patient interview part of the CMS Recertification Survey is about modality knowledge and satisfaction? 

This month, we are including the surveyor worksheet for an in center hemodialysis patient interview. Have your staff and patient volunteers/PAC members role play a MOCK State DOH Patient Interview. 
Simulation-based learning can help improve clinician performance, and can help to educate patients. For more information on integrating simulation into your education plans, please see a recent article from IHI  Including Simulation in Your Improvement Plans.

CROWNWeb HT Data Entry Tip Sheet. This tip sheet was designed to assist facility staff in properly entering Home Therapies Training into CROWNWeb. (All QIA data is drawn from CROWNWeb data - it is important that your facility data is correct)

On this month's feedback form  we ask for you to:
  • Report the results of your facility's use of the Patient Interview Worksheet PDF.
  • Upload Pictures of your Education Station/Visual Displays
  • Let us know if the CROWNWeb Tip Sheet  PDF was useful.
  • Report any Rapid Cycle Improvements implemented at your facility during this QIA.
We have created a printable worksheet PDF to
assist you with filling out the
online Feedback Form.
 June Feedback Form reporting will be due on
June 30, 2018.

Thank you for all of your efforts in this QIA. 
June Activities
Discuss:  Rapid Cycle Improvement- Speak with your staff, patients and administration about any changes that you have made/need to make to your Treatment Options Education Process.  Report any Rapid Cycle Improvements implemented ?

Team Building Activity: Please download and print this Patient Interview Worksheet (extracted from the CMS  State Survey Agency Field Manual

Use the worksheet to identify gaps in patient education, and then discuss these gaps and how to overcome them in your next QAPI meeting.

Simulate a Patient Interview(s):  Wouldn't it be better for you and your staff to find the deficiencies BEFORE the SA does? Either as an in-service, or as a separate meeting ask for staff and patent volunteers to interview using the worksheet. Have a staff member take notes when there is discussion about the topics, and then, meet with staff to address any potential gaps in education and plan to address the gaps in your next QAPI meeting. (HINT: these steps could be considered Rapid Cycle Improvement) 
Report:  (Due 6/30/2018) Worksheet PDF; online form

All Facilities MUST report feedback, but you ONLY need to report 7 step data if your facility is NOT part of an LDO (DaVita, DCI, FMC).

Register/Attend (at least 1 staff member) the ESRD NCC Home Therapies LAN call on June 12, 2018. (See below)
National Home Therapies LAN Call:

Tuesday, June 12, 2018 from 3-4pm
Pre Registration Required

Presentation Objectives:
  • Discuss what is happening to patients in the first year of dialysis in the United States.
  • Educate attendees about the concept of a transitional care unit.
  • Highlight how to set up a transitional care unit.
About the presenters
Robert S. Lockridge Jr., M.D., is a retired clinical nephrologist and member of Lynchburg Nephrology Physicians. He was medical director of the home dialysis program at Lynchburg Dialysis Facility. He grew the peritoneal program from no patients in 1982 to 60 peritoneal dialysis (PD) patients by 1996. Dr. Lockridge started the first nocturnal home hemodialysis program in the United States in September 1997.
Presently, Dr. Lockridge is actively involved in educating nephrology physician groups, home training nurses, renal social workers and renal dietitians in the United States and Canada about the practical aspects of home hemodialysis (HHD), who are candidates, and how HHD is prescribed.

Lisa Hart, MSN, CNN, is the Optimal Transition Manager at Satellite Healthcare in Sacramento, CA. She has been heavily involved in design, development, implementation and management of the Optimal Transitions program, delivering intensive education on all modalities. Ms. Hart has worked as a nurse in the dialysis field for 30 years with experience in hemodialysis, peritoneal dialysis, home hemodialysis (HHD) and clinical management. She has received her Master's in Nursing Education with a particular interest in educating patients. She is a Certified Nephrology Nurse.

Past Activities
QIA Education Materials

Flyer: What are my treatment choices? PDF
Booklet: Considering your treatment choices PDF
Booklet: Know the Facts about Home Dialysis Choices PDF
May Successes:
A patient was accepted for solo home training!

May Barriers:
Patient Lack of Interest
Past HT Failures (PD and HHD)
Surgeon's availability
Failed catheter

Materials Available: 
April National Home Modality LAN
Topics covered:
Education strategies that build and/or strengthen relationships between staff and patients to overcome barriers.

Patient-centered activities that identify gaps between patients' goals and current quality of life.

Strategies for overcoming barriers that impact a patient's perceived suitability for home modalities.
Approaches that decrease home admission wait time through collaboration between regional home programs.
We Want to Hear from YOU!
Please contact the Quality Improvement Department if you have questions, comments, or specific barriers that you would like to address.  Let us know if you have identified any best practices that you would like to share with the community.
About the 2018 Home Therapies QIA
The IPRO End Stage Renal Disease (ESRD) Network of New York is contracted by the Center for Medicare & Medicaid Services (CMS) to launch Quality Improvement Activities in the Network Service area.  30% of dialysis facilities have been targeted in New York state to improve the Utilization of Home Therapies. (Peritoneal Dialysis and Home Hemo Dialysis)

Facilities in this QIA are targeted to increase the number of patients utilizing appropriate home dialysis by 10% during this project period. Ultimately, CMS has a goal to increase the national average of patients utilizing home dialysis to 16% in 2023 from just 12% in 2016.

CMS has a developed a seven step methodology to track patient progression through the process of changing modality from in-center hemodialysis to an appropriate home  modality. The seven steps are as follows:
  1. Patient interest in home modality
  2. Educational session to determine the patient's preference of home modality
  3. Patient suitability for home modality determined by nephrologist, with expertise in home dialysis therapy
  4. Assessment for appropriate access placement 
  5. Placement of appropriate access
  6. Patent accepted for modality training
  7. Patient begins home modality training
In collaboration with the National Coordinating Center (NCC) and dialysis facilities the Network will track and monitor patient progression through these seven steps. The Network will assist facilities with identification with root cause(s) that may impede patient progression. Facilities will participate in a bi-monthly Learning and Action Network (LAN) presented by the NCC to facilitate that sharing of best practices to promote appropriate home dialysis.