Increasing Rates of Patients Dialyzing at Home
Quality Improvement Activity (QIA)

Network Project Lead: Karen Ripkey, RN, BSN, CNN

Project Description and Goals

Home dialysis modalities are underutilized in the USA with only 8% of the dialysis patients undergoing renal replacement therapy at home versus 92% being treated with center hemodialysis. As a result, the following AIM with a 5-year target has been set to guide national health promotion and management to improve the health of all people in the United States living with ESRD: by 2023, increase the number of ESRD patients dialyzing at home to 16% from the 2016 national average of 12%. 
The intent of the Home Dialysis QIA is to promote referral to home dialysis modalities, identify and mitigate the barriers to timely referral in each of seven steps to initiation of home modality, and determine the steps patients and providers can take to improve referral patterns. Facilities will demonstrate at least a 10 percentage point increase in the rate of patients that start home dialysis training by data available in October 2018. 
The ESRD NCC Home Dialysis LAN has three primary purposes.  The first is to improve information communication across care settings, with emphasis on communication between in-center dialysis centers and home dialysis centers to promote and support transition of care for ESRD patients. The second is to promote and support communication internally between in-center and home modality staff to educate patients.  The third is to increase awareness of and ways to support the patient through training for a home modality.

Seven Steps to Initiation of Home Dialysis Therapy 

  1. Patient interest in home dialysis
  2. Educational session to determine the patient’s preference of home modality
  3. Patient suitability for home modality determined by a nephrologist with expertise in home dialysis therapy
  4. Assessment for appropriate access placement
  5. Placement of appropriate access
  6. Patient accepted for home modality training
  7. Patient begins home modality training

Monthly Reporting Link

PDSA Worksheet to Use for Monthly Reporting Link

Home Dialysis Resource Toolkit


Quality Improvement Toolkit 

Home Dialysis Toolkit

“Seven Steps” Resources

5-Diamond Patient Safety Program

Patient Stories

My Life My Dialysis Choice

Home Dialysis Articles

CMS Conditions for Coverage