Implementation and effectiveness of a supportive care learning collaborative for hemodialysis

ABSTRACT

Background: The objective of this study was to determine whether a learning collaborative for hemodialysis providers improved delivery of supportive care best practices. Methods: Ten U.S. hemodialysis centers participated in a hybrid implementationeffectiveness pre-post study targeting seriously ill patients between April 2019 and September 2020. The collaborative educational bundle consisted of learning sessions, communication training and implementation support. The primary outcome was change in proportion of seriously ill patients with complete advance care planning (ACP) documentation. Healthcare utilization was a secondary outcome and implementation was assessed qualitatively. Results: One center dropped out during the COVID-19 pandemic. Among the remaining nine centers, 22.9% (320/1395) of patients were identified as seriously ill in the pre-intervention period and 18.0% (226/1254) were identified in the post-intervention period. From the pre-intervention to post-intervention period, the proportion of patients with complete ACP documentation increased, and hospitalizations and emergency department visits decreased (Table). There was no difference in mortality, palliative dialysis, hospice referral or dialysis discontinuation. Screening for serious illness was widely and sustainably adopted. Goals of care discussions were adopted with variable integration and sustainment. Conclusions: Supportive care best practices were feasible to implement in hemodialysis centers and largely sustained during the COVID-19 pandemic. We observed increased documentation of ACP and lower healthcare utilization after the intervention which could reflect a combination of collaborative and pandemic effects. (Table Presented) .