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Kidney Week

Abstract: PO0830

Implementation and Effectiveness of a Supportive Care Learning Collaborative for Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kurella Tamura, Manjula, Stanford Medicine, Palo Alto, California, United States
  • Stedman, Margaret R., Stanford Medicine, Palo Alto, California, United States
  • Han, Jialin, Stanford Medicine, Palo Alto, California, United States
  • Asch, Steven M., Stanford University, Stanford, California, United States
  • Moss, Alvin H., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Aldous, Annette, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, United States
  • Harbert, Glenda, The George Washington University School of Nursing, Ashburn, Virginia, United States
  • Nicklas, Amanda C., The George Washington University School of Nursing, Ashburn, Virginia, United States
  • Lupu, Dale, The George Washington University School of Nursing, Ashburn, Virginia, United States
  • Holdsworth, Laura, Stanford Medicine, Palo Alto, California, United States
Background

The objective of this study was to determine whether a learning collaborative for hemodialysis providers improved delivery of supportive care best practices.

Methods

Ten U.S. hemodialysis centers participated in a hybrid implementation-effectiveness pre-post study targeting seriously ill patients between April 2019 and September 2020. The collaborative educational bundle consisted of learning sessions, communication training and implementation support. The primary outcome was change in proportion of seriously ill patients with complete advance care planning (ACP) documentation. Healthcare utilization was a secondary outcome and implementation was assessed qualitatively.

Results

One center dropped out during the COVID-19 pandemic. Among the remaining nine centers, 22.9% (320/1395) of patients were identified as seriously ill in the pre-intervention period and 18.0% (226/1254) were identified in the post-intervention period. From the pre-intervention to post-intervention period, the proportion of patients with complete ACP documentation increased, and hospitalizations and emergency department visits decreased (Table). There was no difference in mortality, palliative dialysis, hospice referral or dialysis discontinuation. Screening for serious illness was widely and sustainably adopted. Goals of care discussions were adopted with variable integration and sustainment.

Conclusion

Supportive care best practices were feasible to implement in hemodialysis centers and largely sustained during the COVID-19 pandemic. We observed increased documentation of ACP and lower healthcare utilization after the intervention which could reflect a combination of collaborative and pandemic effects.

Table. Advance care planning and health care utilization among seriously ill hemodialysis patients
ACPPre-implementation N=258Post-implementation N=196p-value
Complete ACP documentation, N (%)94 (36.0)77 (39.0)<.001
Any ACP documentation, N (%)156 (60.5)151 (77.0)<.001
Healthcare UtilizationPre-implementation N=320Post-implementation N=22p-value
Died, N (%)21 (6.6)14 (6.2)0.86
Emergency department visit, N (%)92 (28.8)43 (19)0.005
Hospitalization, N (%)153 (47.8)73 (32.3)<.001
Palliative dialysis, N (%)4 (1.3)5 (2.2)0.29
Referred to hospice, N (%)7 (2.2)3 (1.3)0.44
Discontinued dialysis, N (%)6 (1.9)1 (0.4)0.10

Funding

  • Private Foundation Support