14. National implementation of the Kidney Team at Home educational intervention

S. Redeker, S.Y. Ismail, R. Timman, J.J. van Busschbach, W. Weimar, E.K.J. Massey

Thursday 5 march 2020

0:00 - 0:00h at Toon Hermans Foyer

Parallel session: Postersessie 4 – Donatie en Verpleegkundige abstracts

Background: Research has shown that home-based education for patients with end-stage renal disease results in better knowledge and communication skills on renal replacement options, and more living donor kidney transplantations compared to care-as-usual. However, these studies were conducted in one region in the Netherlands. The aims of this study were (1) to assess whether the effects can be replicated when the intervention is implemented nationally (thus demonstrating generalizability), and (2) to evaluate the implementation process.

Methods: In the period 2016-2018, 4 university hospitals and 4 regional hospitals in 4 regions of the Netherlands participated in the implementation project. Both pre-dialysis and dialysis patients and their social network were offered the intervention. The education was delivered by trained social workers, psychologists and nurses. Effect outcomes of the intervention were patients’ and invitees’ knowledge on renal replacement therapy, communication skills between the patients and the invitees of the intervention, and the choice of treatment of patients after the intervention. Feasibility (participation rate), fidelity (protocol adherence), and implementation costs (intervention costs) were assessed as part of the process evaluation.

Results: 812 patients with end-stage renal disease were approached for the intervention and 334 interventions were conducted. There was a significant increase in knowledge and communication skills among both patients and invitees. At the 2 year follow-up 59 participants had undergone a living donor kidney transplantation and another 53 patients were in a living donation trajectory. Participation rate per hospital varied between 32.9% and 100%. The average protocol adherence score was 4.69 out of 5. Intervention cost is estimated to lie between €2500 and €3000 per patient educated.

Conclusions: The results of the implementation project show that the intervention can be implemented nationwide in The Netherlands, while maintaining impact and quality. Variability among the hospitals in terms of feasibility and fidelity might be the result of regional differences, and the degree to which the intervention was embedded in the established nephrology care path. We recommend uptake of the Kidney Team at Home in standard-care and structural financing for this effective form of education.