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Kidney Week

Abstract: PO1257

Development of a Robust Peritoneal Dialysis Program

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Valle, Gabriel A., Kidney and Hypertension Group of South Florida, Fort Lauderdale, Florida, United States
  • Valle, Barbara K., Kidney and Hypertension Group of South Florida, Fort Lauderdale, Florida, United States
Background

Despite ample evidence supporting the superior performance of Peritoneal Dialysis (PD) in a value-based heathcare system, this modality remains conspicuously underutilized in the USA. We implemented a multifaceted strategy to develop a high-performing PD facility in 28 months.

Methods

VIPKH, a private PD Center, was created through an affiliation with a five-doctor nephrology group in Florida and Medicare Certified 8/2017. Our physicians adopted an “upstream” approach to patient selection by promoting timely access to care for CKD 3b/4/5. KD education was mandatory. Social Media storytelling fostered a vibrant virtual CKD community. Patient vetting incorporated multidisciplinary evaluation of support systems and socio-economic and cultural determinants of health within their specific ecosystem. Expedited referral to an expert surgeon for laparoscopic catheter insertion was crucial. Home training and on-demand home visits were conducted routinely. 24/7 tele-access to clinicians and an open-door policy for non-routine care was instituted. Two satellite locations were available. FTE staff included an Administrator/Population RN, two PDRN, Assistant Administrator and PTE RD and MSW.

Results

From 9/2017 through 12/2019 (28 months), 66 patients were admitted to VIPKH (Program Vintage 58 PD patient/years). Demographics: female 50%, 64.7 years (25-86), Caucasian 55%, African-american 23%, Hispanic 15%. Comorbidities: DM 47%, CHF 36%, DM/CHF 21%, Morbid Obesity 14%. As of 12/31/2019, 37 patients were on CCPD with good adequacy, 29 discharged: 1 Recovery, 7 Transplant, 3 Relocation, 4 Deceased, 1 Hospice, 13 Dropouts (5 peritonitis, 1 tunnel infection, 2 leaks, 1 inadequate dialysis, 3 disability, 1 burnout). Performance rates per 100 ESRD patient years (VIPKH vs Benchmarks): Peritonitis (10 vs 25), tunnel infection (2 vs 8), admissions (72.6 vs 170), hospitalization days (631 vs 1120), 30 day readmission (16.7% vs 37%), ED/Short-Stay (12.1 vs 350), transplant (12.9 vs 3.5), mortality (6.9 vs 22.5).

Conclusion

Our outcomes reflect the delivery of exceptional PD care. Our pragmatic approach to developing a successful PD program encompasses humble leadership which lays the foundation for building powerful relationships between all stakeholders through effective communication, education and collaboration, promotes shared decision-making and facilitates timely access to integrated, longitudinal, patient-centered care.

Funding

  • Clinical Revenue Support