Inter-CEPt
Research type
Research Study
Full title
Intervening to eliminate the centre effect variation in home dialysis use
IRAS ID
281908
Contact name
Simon Davies
Contact email
Sponsor organisation
Keele University
Duration of Study in the UK
2 years, 8 months, days
Research summary
Summary of Research:
30,000 people with kidney failure in the UK have their treatment, called dialysis, either at home or at their local dialysis unit as an out-patient, provided by staff. National guidelines encourage the use of home dialysis treatment because there are many advantages. The problem is that some kidney treatment centres provide home treatment to more patients than other centres. In this study, we aim to understand the complex reasons why home therapies are not used more equally and fairly by kidney centres across the country. We will also design and test a number of possible solutions to improve the uptake of home therapies.This study has five parts:
(1) We will undertake a detailed investigation in four centres with varying success in using home therapies to gain deep insights into the reasons of these differences in uptake.
(2) We will use these insights to create a survey of all centres across the country. The results will be
analysed in a way that incorporates all factors that can explain variation between centre in the use of home therapies.
(3) Because home therapies have been shown to be cheaper, there are potentially very significant
savings for the NHS. We will use the information from our research to determine the savings that could be realised.
(4) We will combine all this new knowledge to work out what the most important factors are that are likely to improve home therapy use that is equal and fair.
(5) We will use this research to develop an approach that can be applied by centres that is acceptable to patients and staff as well as being practical and feasible.This research will benefit patients and the NHS by improving uptake of home therapies, helping people with kidney disease improve their quality of life and reducing costs.
Summary of Findings:
The Inter-CEPt study was designed to develop an intervention that would address the unwarranted variation in uptake of Home Dialysis across England. We used a number of approaches to understand the characteristics of dialysis centres that are successful in enabling their patients to get their dialysis at home. These included an ethnographic study, i.e. a deep dive into the practices of four centres in which patients, family members and staff were interviewed, and their organisational processes were observed. This was followed by a national survey of all the dialysis centres in England asking them about how they delivered Home Dialysis. The findings of the survey were correlated with data from the UK Renal Registry to see how the survey responses aligned with what actually happened to 32,000 patients starting dialysis since 2015. Taking all these approaches together we established that the organisation culture, including leadership, support of patients and their approach to service development was more important than how their services were organised. Adequate resourcing of staff was also important and in a parallel health economics study we were able to show that Home Dialysis is a cost-effective treatment that dialysis centres should invest in.We used these findings to develop an intervention. Working with patients, their families, professionals (nurses and doctors), policy leaders and industry representatives we identified the key components of this intervention: distributed leadership to embed a strong Home Dialysis organisational culture by introducing the use of existing tools designed to empower patients coupled with the application of quality improvement. The next step is to test this intervention in centres that perform below average in Home Dialysis provision. To learn more about this intervention please obtain a copy of the report “Location of Dialysis Care in Kidney Life” from Kidney Research UK. Patients and their families were involved in every step of this research from inception to dissemination and the research team is indebted to them for their invaluable support.
REC name
Wales REC 6
REC reference
20/WA/0249
Date of REC Opinion
18 Sep 2020
REC opinion
Favourable Opinion