A path to expanded opportunities and patient-centered care
In 2022, a BC Renal province-wide review of home dialysis revealed significant inconsistencies in how different programs screen and refer patients for home dialysis, contributing to disparities in access and missed opportunities to recruit eligible home dialysis candidates. The review also underscored communication gaps between kidney care providers, patients, and their caregivers during the referral process, as reflected in a separate 2022 patient experience survey. These findings prompted the need for a standardized provincial approach to ensure a consistent, transparent home dialysis pathway, and that all eligible patients receive a comprehensive assessment.
BC Renal, via our provincial Peritoneal Dialysis (PD) and Home Hemodialysis (HHD) Committees, subsequently prioritized a project for 2023-2024 aimed at standardizing the screening and referral process across the province.
The project had three main objectives:
- identifying current provincial screening and referral processes,
- understanding patient and caregiver needs during referral decision-making, and
- developing a consistent provincial referral pathway.
The ultimate goals were to:
- increase the uptake of home dialysis,
- ensure patients received adequate support throughout the process, and
- improve staff awareness and comfort in handling home dialysis referrals.
A mixed-method, three-part quality improvement and implementation study was designed to test whether a standardized provincial pathway would enhance the identification of eligible home dialysis candidates. The initiative targeted facility-based hemodialysis patients who had not yet transitioned to home dialysis or were undecided about their long-term dialysis modality. A diverse working group of nephrologists, nurses, administrators, and patient partners guided the study.
The first phase, launched in April 2023, involved an environmental scan across all health authorities through surveys of providers and BC Renal patient partners. Provider surveys explored existing practices, barriers, and suggestions for improvement, while patient surveys gathered insights into experiences and preferences regarding home dialysis. The data were analyzed to inform the next phase of the project.
In the second phase, a
home dialysis screening and referral pathway was developed and piloted across three health authority renal programs at several sites in the cities of Prince George, Kelowna, Abbotsford, Surrey and New Westminster. Staff, particularly hemodialysis nurses, participated in virtual education sessions on the new pathway. They appreciated having a tool to open conversations about home dialysis with their patients and refer them for assessment if they were interested. The importance of ‘home dialysis champions’ (engaged, enthusiastic and motivated staff about home modalities) in each site was noted. Feedback was collected throughout to refine the process. Following the pilot, surveys assessed staff comfort and understanding of the pathway.
The third phase is focusing on province-wide implementation until December 2024. This includes live virtual training sessions for multidisciplinary teams, and regular updates shared through various channels to maintain engagement and transparency.
“Personally, working on this project has allowed me to engage with different programs across the province, gaining first-hand insight into their strengths and limitations,” says Dr. Megan Borkum. “As a Masters of Health Administration student, this perspective has been invaluable in deepening my understanding of the health-care system. Additionally, I had the privilege of presenting the first phase of the project and its resources at the International Society of Peritoneal Dialysis Congress in Dubai in September."
Dr. Borkum adds, "Engaging with colleagues at this event made me realize how fortunate I am to work in BC with such dedicated and dynamic professionals, all driven to improve our province's health-care system and patient experience.”
Six months after full implementation, various quality improvement measures (e.g., home dialysis uptake from hemodialysis) will be assessed. They will be compared with previous rates to evaluate the success of the standardized process.
Patient resources:
Intro to Home Dialysis Resources (one-page resource with QR codes to connect patients to online written guide of dialysis options, webinars, peer support, and videos)
