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

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.

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.

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.

The intervention was predicted to lead to an increase in both the number of patients receiving modality education and those choosing home dialysis.

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.

Statistical process charts were used for monitoring changes in education uptake and home dialysis selection rates following the intervention.

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.

The study was limited to 1 center, without evaluating patient satisfaction or dissecting the complexity of educational content and delivery.

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.