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Kidney Week

Abstract: FR-PO502

Reduction of Peritonitis in an Integrated Health Care System: Collaboration Between Nephrologists, Dialysis Provider, and Health Plan

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis


  • Zheng, Sijie, The Permanente Medical Group, Oakland, California, United States
  • Reddy, Chitra R., Kaiser Permanente, Daly City, California, United States
  • Halick, Gary V., Kaiser Permanente, Daly City, California, United States
  • Alcaraz, Maribeth Ann, Kaiser Permanente, Daly City, California, United States
  • Bhalla, Neelam M., The Permanente Medical Group, Oakland, California, United States

Peritonitis is a serious complication in patients on peritoneal dialysis (PD). Centers for Medicare and Medicaid Services (CMS) has set peritonitis rates as a performance metric for PD clinics. Kaiser Permanente (KP) Northern California is an integrated health care system with 4.4 million members. In 2018, a workgroup was created to monitor and reduce peritonitis rates in 3 non KP PD clinics with high rates.


A KP workgroup was formed consisting of 3 non KP PD Medical Directors, a RN Clinical Practice Consultant, and a Regional Health Plan Director. The work group outlined performance improvement tools: 1. The facility’s P&Ps were aligned with ISPD guidelines and adherence to P&P monitored; 2. Workflow for patient education and training; 3. Root cause analysis for peritonitis. After an initial site visit, monthly conference calls were held with the work group and facility staffs to review all peritonitis episodes and perform a Root Cause Analysis.


The work group identified several factors that had contributed to peritonitis: 1. Patients that experienced peritonitis were not incident patients, but with a vintage of 2+ years; 2. Patient training and retraining was not consistent; 3. The education and training was not done in an organized manner and there was no enforcement and oversight of this process. The following actions were taken by KP in conjunction with the facility team- 1. P&Ps were reviewed, and staff informed of goals; 2. Staff and management buy-in was obtained to empower and drive improvement. As a result, of the initiative, there was a reduction in the peritonitis rates in all the three facilities (Figure).


In an integrated health care system, creating a dialysis provider and health plan partnership to implement a culture of cooperation is a unique approach to improve patient care. The partnership led to collaboration of care for better outcomes.