This document discusses a proposed national improvement project called KQuIP to increase home dialysis rates across the UK by addressing regional variation. It would establish regional collaboratives to test ideas and share best practices using a three-phase model of discovery, idea development, and testing cycles. Barriers to greater home dialysis use include financial factors, lack of leadership support and expertise, and perceptions of patient suitability. The project aims to standardize training pathways and measurement while respecting patient choice. Clear vision, leadership, organizational culture, and infrastructure support will be key drivers of success.

1. Home Dialysis
Improvement project

2. Why?
• Home dialysis
• Includes PD and HD
• Includes self and assisted care models
• Benefits
• Personal
• Medical
• Quality of life
• System
• Resources

3. Guidance
• Professional guidance
• NICE
• 2002
https://www.nice.org.uk/guidance/t
a48
• Renal Association
• Peritoneal Dialysis in Adults and
Children June 2017
• Research evidence
• Patient organisations

4. Attitudes positive in the main …..
BMC Nephrol. 2014 Jan 15;15:16. doi: 10.1186/1471-2369-15-16.

5. …… but disconnect with delivery
UK Renal Registry 18th Annual Report

6. Variation across UK is high
0.0
5.0
10.0
15.0
20.0
25.0
Carsh L Barts L Guys L Kings L Rfree L St.G L West
Data taken from UK Renal Registry % prevalent patients on home dialysis modality
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0

7. Progress is slow (or stagnant) Fall in PD >
growth in HHD
UK Renal Registry 18th Annual Report

8. Why?
• 185 respondents
• 50% at meeting
• MDT mix (30% medic, 35% nurse)
• Resources – red
• Patient factors – dark blue
• Service factors – light blue
All respondents Low leadership barrier

9. Responses
Answer Options Rating Average (all) Rating Average Low leadership barrier
Reimbursement for home dialysis (i.e. what centres get paid) 2.21 2.00
Equipment, consumables and installation cost 2.42 2.22
Patient housing unsuitable 2.91 2.82
Patient and carers choice or desire 2.82 2.63
Patient frailty or illness 3.14 3.04
Staff knowledge and confidence 2.40 2.10
The in centre HD unit referral rate 2.57 2.21
Pre dialysis team referral rate 2.21 1.92
Business planning or management support 2.70 2.32
Champions or leaders for home therapies 2.25 1.52
Bias from clinical teams 2.48 2.07
Resources for training of patients and carers 2.60 2.33
Patient knowledge and confidence 2.80 2.60
Resources to support people at home 2.72 2.48

10. Why?
• Financial concerns were not the main barriers.
• Strong leadership and a positive organisational culture were the main
contributors towards successful home dialysis programmes.
• Change management skills to deliver sustainable, systematic and
evidenced change are needed.
• Patient factors – frailty, choice – were important determinants, but
less so in some leadership systems.
Manchester Home Dialysis Forum 2016 Workshops

11. To increase the
proportion of patients on
home dialysis therapies
in England
Clear Vision & Purpose
Leadership
i) Organisational ii) Medical iii) Nursing iv) Patient Leadership
Organisational Culture
Values, behaviours & mindset
Expertise [Knowledge& skills]
Patients
Determining ‘suitable’ home dialysis patients
Develop patient exclusion criteria, dependent on local expertise
Home dialysis training
Effectiveness & experience of training pathway
Patient awareness, recruitment & retention
Patient Education & Informed Choice; Patient & carer experience;
Peer support; Carer support
Organisational Infrastructure
Financial support
Training facilities
Commissioning dialysis consumables and machines
Home modifications
Access to respite care
Multidisciplinary team supported by community team
DRIVER DIAGRAM: Home Dialysis

12. The KQuIP proposal
• A national improvement project
• Based upon regional
collaboratives or networks
• Central support from KQuIP
• Coproduction

13. Perception of suitability
X
System efficacy
=
Probability of home dialysis
Leadership
Skills, knowledge and
confidence
Culture
Measurement

14. How?
• Our Shared Vision
• To reduce regional variation and
improve delivery of home
dialysis in order to
• Improve the experience of care of
individual patients and their
families
• Improve the value of care by
improving outcomes at the same
or reduced cost.
• Sponsored by national
stakeholders
• Operational support from UKRR
KQuIP team
• Regional networks supported by
project management time
• Regions to establish regional
teams and provider teams to
lead work – MDT & service user
integrated

15. Three phases to improvement at network
level
• Step 1: Research and discovery
• What works well, regionally or
nationally?
• What can you use or adapt?
• How will you measure success?
• Step 2: Ideas
• Develop long list of ideas
• Refine list by discussion
• Agree final list

16. • Step 3:
• Test ideas
• Agnostic to QI methodology
• Embrace uncertainty
• Collect evidence
• Present and refine (or abandon)
• Repeat cycle
Start PD pathway
Plan dialysis access - insert PD catheter
Patient and MDT sign off for PD pathway
Assess for suitability– clinical, patient factors and home
suitability
Screen low clearance, Prevalent HD, Incident HD, Failed Tx
Identify potential PD patients through shared decision making
MDT review

17. Next steps
• Funding
• Project plan
• Steering committee established
• Define data set
• Clinical
• Patient – PAM, PREM, PROM
• Process measures
• Balancing measures
• Network applications
• Launch for project initiation Sept
2017
• Project start (network 1) April 2018