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Veterans Health Administration Peritoneal Dialysis Program Infrastructure and Clinical Practices: Findings from a
Michael J Fischer1,2, Scott Reule3,4, Kerri L Cavanaugh5,6
1Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois.
Summary
Peritoneal dialysis (PD) use is lower in US Veterans. A survey revealed significant variation in PD infrastructure and practices across VHA programs, impacting quality and access for kidney failure patients.
Area of Science:
- Nephrology
- Healthcare Administration
- Public Health
Background:
- Peritoneal dialysis (PD) utilization is lower among US Veterans compared to non-Veterans with kidney failure.
- The Veteran Healthcare Administration (VHA) prioritizes enhancing home dialysis options for Veterans.
- A comprehensive assessment of VHA PD programs was lacking.
Purpose of the Study:
- To assess the current infrastructure and clinical practices of VHA Peritoneal Dialysis (PD) programs.
- To identify factors influencing the selection, access, and quality of PD services for Veterans.
- To inform strategies for improving PD care within the VHA system.
Main Methods:
- A nationwide survey was conducted among VHA PD programs.
- Stakeholders responded to electronic questionnaires regarding PD infrastructure and clinical practices.
- Data from 27 VHA PD programs (100% response rate) were analyzed.
Main Results:
- Significant facility-level variation exists in PD infrastructure, services, staffing, and clinical practices.
- Larger PD programs (≥10 patients) offered more services and better guideline adherence than smaller programs (<10 patients).
- Differences were noted in training, staffing ratios for PD nurses, and PD initiation/maintenance protocols.
Conclusions:
- Substantial variability in PD infrastructure and practices exists within the VHA, particularly between small and large programs.
- Program-aligned infrastructure, standardized practices, and quality improvement initiatives are crucial for increasing successful PD utilization.
- Addressing these variations can improve PD choice, access, and quality for Veterans with kidney failure.
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