Introduction of Renal Key Performance Indicators Associated with Increased Uptake of Peritoneal Dialysis in a Publicly Funded Health Service

Abstract

♦ BACKGROUND: Increased demand for treatment of end-stage kidney disease has largely been accommodated by a costly increase in satellite hemodialysis (SHD) in most jurisdictions. In the Australian State of Victoria, a marked regional variation in the uptake of home-based dialysis suggests that use of home therapies could be increased as an alternative to SHD. An earlier strategy based solely on increased remuneration had failed to increase uptake of home therapies. Therefore, the public dialysis funder adopted the incidence and prevalence of home-based dialysis therapies as a key performance indicator (KPI) for its health services to encourage greater uptake of home therapies. ♦ METHODS: A KPI data collection and bench-marking program was established in 2012 by the Victorian Department of Health and Human Services, with data provided monthly by all renal units in Victoria using a purpose-designed website portal. A KPI Working Group was responsible for analyzing data each quarter and ensuring indicators remained accurate and relevant and each KPI had clear definitions and targets. We present a prospective, observational study of all dialysis patients in Victoria over a 4-year period following the introduction of the renal KPI program, with descriptive analyses to evaluate the proportion of patients using home therapies as well as home dialysis modality survival. ♦ RESULTS: Following the introduction of the KPI program, the net growth of dialysis patient numbers in Victoria remained stable over 4 years, at 75 - 80 per year (approximately 4%). However, unlike the previous decade, about 40% of this growth was through an increase in home dialysis, which was almost exclusively peritoneal dialysis (PD). The increase was identified particularly in the young (20 - 49) and the elderly (> 80). Disappointingly, however, 67% of these incident patients ceased PD within 2 years of commencement, 46% of whom transferred to SHD. ♦ CONCLUSIONS: Introduction of a KPI program was associated with an increased uptake of PD but not home HD. This change in clinical practice restricted growth of SHD and reduced pressure on satellite services. The effect was offset by a modest PD technique survival. Many patients in whom PD was unsuccessful were subsequently transferred to SHD rather than home HD.

Hemoglobin dan Adekuasi Berkorelasi dengan Kualitas Hidup dan Kinerja Jantung Pada Pasien Hemodialisis

“…Untuk mengevaluasi keberhasilan program HD, diperlukan metode yang mampu menilai parameter kualitas layanan unit HD secara keseluruhan baik dari segi sumberdaya, proses dan output klinis. 6,7 Indikator Kinerja Utama (IKU) ginjal mulai berkembang sejak awal dekade ini untuk mendorong peningkatan layanan terhadap pasien PGK yang menjalani HD. 6 IKU ginjal juga dibuat untuk menilai kinerja unit HD sehingga mampu memberikan layanan paripurna serta menghasilkan target HD yang telah ditetapkan.…”

A View of the Bundle from a Home Dialysis Perspective

“…These data do not inform us about the prevalent PD population, which is determined by incidence as well as patient and technique survival. This is particularly relevant because of the findings in Australia when a government-mandated performance measure was implemented to encourage growth in home dialysis (9). Although the measure succeeded in increasing the PD incidence rate, early technique failure was a concern, affecting prevalence.…”

Intervening to eliminate the centre-effect variation in home dialysis use: protocol for Inter-CEPt—a sequential mixed-methods study designing an intervention bundle

“…Perceived care giver burden has also been linked to low uptake of home therapy 29–31. In Canada, Australia, New Zealand and the USA, home dialysis may come at an increased cost to individuals, referred to as ‘out of pocket costs’ 26 30 32–34. These costs, unknown in the UK, might also act as barriers to home dialysis 3 23…”

“…However, it is likely that institutional culture also plays an important part, with opinions and biases that staff might have regarding home dialysis impacting how effectively (or not) the unit promotes home therapy 11 14 18 27 286 27 29 36–38 World wide, several studies and systematic reviews have explored the influence of policy on home dialysis,28 37 39 showing that a combination of educational programmes for patients and staff,36 40 targets, performance indicators and financial incentives can increase home therapy uptake 25 34 41 42. It is not clear whether these approaches are sustained over time, but increased use of PD in the USA was not associated with a detrimental effect on survival 43.…”