Behind the Expansion of Home Dialysis, Rigorous Training and Texting

More training and the use of timely communication are helping home dialysis patients overcome some of the workflow problems they face there.

Home-based kidney dialysis remains a relative rarity, with only one in ten U.S. patients able to receive peritoneal dialysis and hemodialysis at home, according to national averages.

But driven by the staggering cost of outpatient dialysis treatments and improvements in home dialysis technology, one chain of dialysis clinics has been able to double that average. And it aims to double it again through an innovative program involving feedback from patients as well as nephrologists and payers.

The costs paid by Medicare tell the tale: While dialysis patients represent less than 1% of the Medicare population, they also represent 6% to 7% of the total cost of Medicare.

Satellite Healthcare, based in San Jose, CA achieved its doubling through its Wellbound Centers, which are dedicated to peritoneal dialysis and hemodialysis and include a training room or space to instruct patients how to perform home dialysis. It serves 7,000 patients in six states.

For two days in June, Satellite brought patients from its service area to San Jose, CA to brainstorm new technology and workflows in an effort to double its home dialysis rate again to 40%.

"There's absolutely a feeling in the nephrology community that we can bring the benefits of home therapies to a greater number of patients," says Graham Abra, MD, medical director at Wellbound San Jose. He is also a practicing nephrologist at Stanford Medicine and clinical assistant professor at Stanford Medical School.

Less Travel, Better Quality of Life

A major benefit of home dialysis is eliminating the travel time required for patients to get to and from dialysis clinics. "They have clinical benefits, in that these therapies in general often lower the number of blood pressure medications and phosphorous-binding medications that patients need to take," Abra says.

"In general, people's quality of life appears to be better on these therapies than on in-center therapies. They recover more quickly after the dialysis treatments that are performed at home. An average in-center patient might take 6 to 8 hours to feel normal after a dialysis treatment, and that could be as low as an hour or so for someone doing home treatment."

Just as Abra believes the dedicated training space at Satellite Wellbound centers has made a big difference in the amount, quality, and effectiveness of home dialysis training, he believes a recent brainstorming session could help dialysis patients at home to get past some of the dialysis workflow problems they face there.

"We heard a lot about the challenges of managing the supplies that are used in the home for peritoneal dialysis and home hemodialysis," Abra says.

Timely Communication

"We heard a lot about the challenges of setting up someone's house in order to do the dialysis at home. I think those are really important details that impact people's quality of life, and often aren't front-and-center in a nephrologist's mind necessarily, [or] even the clinic staff."

Abra points to the Apple iPhone's text messaging as an example of a technology which is currently underutilized to smooth issues and improve patient experience.

He says he was "really struck by the idea that many of our patients have struggles with communicating in a timely manner back and forth with the clinic, with keeping track of their treatment logs, with supply ordering, with alarms that frequently come up on [their home] machines for which they have to search through a big binder of stuff to figure out what they are."

Abra thought technology could be "very helpful."

"All these things kind of scream, 'gosh, put that in an app that can be easily accessed on a tablet or a smartphone, so that you can quickly communicate with your healthcare provider either by text or image.'"

"You can quickly look up common things that are happening with your dialysis machine and troubleshoot it, you can potentially send in your logs electronically so that you're not dealing with pencil and paper, and your healthcare team has timely access," he says.

"There's been huge impetus and focus on advancing the quality."

Satellite executives are in the midst of ranking the many ideas that came out of the workshop, and plan to roll out innovations at small scale in several Wellbound Centers before deploying them widely.