Strategies to Improve Access to Home Dialysis in Rural Areas

Healthcare administrators are faced with many challenges including creating strategies for more end stage renal disease patients on home modalities and converting current in-center hemodialysis patients to a home dialysis modality. The purpose of this integrative review was to create strategies to increase home modality utilization in rural communities. The review question focused on best practices that can be implemented to increase home modality utilization for rural chronic kidney disease patients. A search of the literature provided an analysis of empirical and non-empirical literature for the past 5 years and resulted in 25 articles that were analyzed in depth to determine themes and subthemes. The Bertalanffy systems theory was used to provide a structure and foundation for the study. The following six main themes were determined to be positive contributions to determine recommendations: education programs, ETC payment model, modality choice, innovation, quality of life, and shared-decision making. The 12 subthemes were the following: web-based, medical record triggers, financial incentives, quality inventive programs, MATCH-D Tool, in-hospital education, telehealth, pre-dialysis education, increased knowledge, remote monitoring advocates, and nephrologist education. Recommendations related to positive social change for the kidney disease health sector is timely education with a structured education process, quality of life outcomes for patients using shared decision-making, and access to home dialysis options for current outpatient dialysis patients.