Abstract: FR-OR076
Through the Looking Glass: Characterizing the Complexity of Outsourcing Veterans Affairs Home Dialysis
Session Information
- What's New at Home (Dialysis)?
November 07, 2025 | Location: Room 351D, Convention Center
Abstract Time: 05:00 PM - 05:10 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Reddy, Yuvaram N.V., VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
- O'Hare, Ann M., VA Puget Sound Health Care, Seattle, Washington, United States
- Agha, Aneeza, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
- Kearney, Matthew D., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- O'Brien, Caroline S., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Grabill, Megan, University of California Los Angeles, Los Angeles, California, United States
- Pelcher, Lindsay, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
- Benson, Jacqueline Andrea, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
- Peeples, Amanda D, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
- Burke, Robert, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
Background
Only 5% of Veterans with kidney failure use home dialysis. While many factors influence home dialysis use, one important factor is that few Veterans Affairs (VA) Hospitals provide home dialysis directly; instead, many outsource care to non-VA providers. Our objective was to characterize clinician and Veteran perspectives on the journey to home dialysis for Veterans outsourced to the community to identify opportunities to improve access to home dialysis.
Methods
In this mixed-methods study, we interviewed Veterans with kidney failure and VA clinicians from 4 VA hospitals across the country. These sites were chosen based on whether they had high or low volumes of home dialysis outsourced by VA. From 10/2022-09/2024, we conducted in-person or virtual site visits where we interviewed participants using a snowball sampling approach. Our approach was informed by the HOME dialysis conceptual model for implementation Research (HOME-R), which characterizes barriers and facilitators to home dialysis along 5 phases of the patient journey. All interviews were transcribed and coded in NVivo by two team members using both deductive and inductive codes. Using the constant-comparison method, the broader team met regularly to identify themes.
Results
We interviewed 3 Veterans and 16 VA clinicians (MDs, RNs, staff). We identified 3 main themes: 1) While somewhat shaped by Veteran preference and travel distance, the decision to outsource home dialysis was often strongly shaped by local VA personnel and capacity; 2) Outsourcing home dialysis often led to fragmented care for patients while contributing to increased administrative burden for VA clinicians that widen care gaps; and 3) clinicians and Veterans suggested increasing VA-based home dialysis infrastructure, enhancing VA staffing for community care, and adopting more standardized processes to streamline communication.
Conclusion
Care coordination can be cumbersome and complex for Veterans outsourced to the community for home dialysis, leading to fragmented care, increased burden, and suboptimal experiences for Veterans and clinicians. VA urgently needs Veteran-centered strategies that simultaneously 1) improve communication and care processes for outsourced care and 2) enhance VA infrastructure for VA-based home dialysis.
Funding
- Veterans Affairs Support