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Cited by 6Palliative Care and End-of-Life IssuesDialysis and Renal Disease ManagementHealth Policy Implementation Science

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Pathways Project Pragmatic Lessons Learned: Integrating Supportive Care Best Practices into Real-World Kidney Care

Open access
Moss, Alvin H., Harbert, Glenda, Aldous, Annette, Anderson, Elizabeth, Nicklas, Amanda, Lupu, Dale E.·2023·Kidney360
DOI 10.34067/kid.0000000000000277PMC PMC10758509
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Abstract

Key Points A multisite quality improvement project using the Institute for Healthcare Improvement learning collaborative structure helped kidney care teams identify seriously ill patients and implement supportive care best practices. Helpful approaches included needs assessment, Quality Assurance and Performance Improvement tools, peer exchange, clinician role modeling, data feedback, and technical assistance. Dialysis center teams tailored implementation of best practices into routine dialysis workflows with nephrologist prerogative to delegate goals of care conversations to nurse practitioners and social workers. Background Despite two decades of national and international guidelines urging greater availability of kidney supportive care (KSC), uptake in the United States has been slow. We conducted a multisite quality improvement project with ten US dialysis centers to foster implementation of three KSC best practices. This article shares pragmatic lessons learned by the project organizers. Methods The project team engaged in reflection to distill key lessons about what did or did not work in implementing KSC. Results The seven key lessons are ( 1 ) systematically assess KSC needs; ( 2 ) prioritize both the initial practices to be implemented and the patients who have the most urgent needs; ( 3 ) use a multifaceted approach to bolster communication skills, including in-person role modeling and mentoring; ( 4 ) empower nurse practitioners and social workers to conduct advance care planning through teamwork and warm handoffs; ( 5 ) provide tailored technical assistance to help sites improve documentation and electronic health record processes for storing advance care planning information; ( 6 ) coach dialysis centers in how to use required Quality Assurance and Performance Improvement processes to improve KSC; and ( 7 ) implement systematic approaches to support patients who choose active medical management without dialysis. Conclusions Treatment of patients with kidney disease is provided in a complex system, especially when considered across the continuum, from CKD to kidney failure on dialysis, and at the end of life. Even among enthusiastic early adopters of KSC, 18 months was insufficient time to implement the three prioritized KSC best practices. Concentrating on a few key practices helped teams focus and see progress in targeted areas. However, effect for patients was attenuated because federal policy and financial incentives are not aligned with KSC best practices and goals. Clinical Trial registry name and registration number Pathways Project: KSC, NCT04125537.

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  • Warm handoffs help reduce fragmentation, clarify roles, and prevent caregivers from being left to coordinate alone.

    “Warm handoffs, direct, relational transitions where responsibility is transferred with the caregiver rather than to them, help reduce fragmentation, clarify roles, and prevent caregivers from being left to coordinate alone [33,34,35,36].”

    From Home care comparison (2026) · cites this paper as [35]

    The Results (Lessons: KSC Practice Pearls; page unavailable) describe nephrologists introducing patients to other staff to continue goals-of-care conversations, calling this a warm handoff. The Discussion says these handoffs helped allocate work among team members, but the paper does not say they reduced fragmentation or prevented caregivers from having to coordinate care alone. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Metadata

Authors
Moss, A. H., Harbert, G., Aldous, A., Anderson, E., Nicklas, A., & Lupu, D. E.
Affiliations
  • West Virginia University (US)
  • Independent Consultant, McKinney, Texas
  • George Washington University (US)
  • Pacific Institute For Research and Evaluation (US)
Corresponding author
Lupu, Dale E.
ORCID
Venue
Kidney360
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-10-27
Volume
4
Issue
12
Pages
1738-1751
ISSN
2641-7650 (ISSN-L)
DOI
10.34067/kid.0000000000000277
PMC
PMC10758509
OpenAlex
W4387964989
Cited by
6
References
45
Citations by year
2026: 3 · 2025: 3
FWCI
1.54
Type
journal article
Language
en
Open access
Licence
Locations
  • Kidney360 (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Gordon and Betty Moore Foundation (#5397, #8039, and #139736)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
kidney supportive care, end-of-life care, advance care planning, dialysis centers, quality improvement, best practice implementation, goals of care discussions, nurse practitioners, social workers, electronic health record documentation, seriously ill patients
MeSH terms
Humans, Kidney, Kidney Failure, Chronic

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