Abstract: FR-PO515
HOME-R: A Home Dialysis Conceptual Model for Implementation Research
Session Information
- Home Dialysis, Policy, Novel Approaches
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 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 System Seattle Division, Seattle, Washington, United States
- Reese, Peter P., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Keddem, Shimrit, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
- Lane-Fall, Meghan B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Burke, Robert, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, United States
Background
The Advancing American Kidney Health initiative aims to grow home dialysis towards 80% by 2025. With <14% of patients currently receiving home dialysis, there is an urgent need to develop strategies to expand home dialysis. To maximize success, a conceptual model of barriers and facilitators is needed to help identify and evaluate strategies to expand home dialysis.
Methods
We reviewed published implementation science models to identify constructs that: 1) aligned with clinical knowledge of home dialysis barriers and facilitators; 2) could be consistently defined, measured, and evaluated in the context of home dialysis; and/or 3) incorporated health equity. We refined the model through an iterative process involving 4 rounds of stakeholder feedback from 4 nephrologists, 3 patients, 3 implementation scientists, 2 nephrology nurses, and 1 care partner.
Results
We developed the HOME dialysis conceptual model for implementation Research (HOME-R, Figure 1) using constructs from two frameworks: 1) the Systems Engineering Initiative for Patient Safety (SEIPS) and 2) the Equity-based framework for Implementation Research (EquIR). HOME-R uses SEIPS to define 5 phases of the home dialysis patient journey and 4 system elements. The 5 phases include referral, patient education, patient training, initiation, and maintenance of home dialysis. At each phase, patients interact with 4 system elements: providers, care partners, the dialysis machine and supplies, and the environment (e.g., home, home dialysis clinic, primary care) – all of which can serve as barriers or facilitators to home dialysis use. HOME-R also uses EquIR to identify and evaluate how social determinants of health modify the influence of system elements on home dialysis.
Conclusion
HOME-R—a conceptual model that incorporates SEIPS, EquIR, and stakeholder input—can be used to identify and evaluate strategies that are designed to improve home dialysis use, quality, and equity.
Funding
- Veterans Affairs Support