“Because we are a free-standing center, surgeons didn’t know what our needs were,” Robar said. “We had a group on nephrologists and surgeons come together to develop protocols for catheter placement and catheter care following placement.”
In addition to surgeons, hospital staff had to be educated and problems had to be fixed.
Every patient has the ability to do home dialysis. Everyone is given the opportunity to fail.
“We do have a rigorous screening tool so that we can not eliminate a patient but know how to best address the issues that they need to overcome,” said Robar.
A physician champion is the most important part of the package, she said. You have to make it convenient for everyone.
John Burkart, MD, professor of nephrology at Wake Forest University Medical Center and CMO for Health Systems Management, said he believes that patients are entrusting the nephrology staff with their lives to get them out of the “trenches.” No one wants to be on dialysis forever. Things have to be done to better the patient care and patient outcomes.
“The probability of being alive, after the first and second years, is better if you are on home dialysis than in-center dialysis,” Burkart said.
Looking at month 60, people on PD have a 41 percent chance of survival versus 35 percent of those on in-center dialysis, he added
Burkart said many physicians don’t think that patients can do home therapies. He said he believes that is completely wrong.
“Maybe we don’t believe our patients can because we don’t think anyone has their back,” he said. “Maybe we don’t think they can because they’re not trainable to do it. We need to start thinking outside the box.”
Since the bundle has been implemented, Burkart said the in-center and home therapies have leveled out when it comes to payment.
One problem in the field is that a physician can call in and say that patient so and so needs to start in-center dialysis tomorrow and there won’t be any questioned asked or concerns raised. With home therapies that is the complete opposite.
“If I call and say that Mary Jean needs to start PD tomorrow, I should not hear ‘um..hold please.’” he said. “That is not going to work; that patient needs to start tomorrow.”
It needs to be easy to start PD and HHD as it is in-center dialysis, he said. Everyone should be on the same level and give the same answer.