MORE HOME DIALYSIS
FOR BETTER HEALTH, QUALITY OF LIFE AND COST CONTROL
In this project, we use design thinking and a person-centered method to improve home dialysis. Through practical tests of communication between hospital staff and home dialysis patients as well as evaluation of dialysis equipment and waste management in the home, we intend to develop new, efficient products and communication models. Having a person-centred approach ensures that users' needs, resources and experiences are at the centre.
Understand and improve
We involve people with kidney disease, healthcare professionals, companies and researchers from the beginning of the project to gather valuable perspectives. The ambition is to gain insights into what prevents a more widespread use of home dialysis, despite its many benefits and potential cost savings. To understand the life situation and health of home dialysis users, we use information from extensive national quality registers. We also investigate why home dialysis is often not presented as an option by healthcare professionals and develop information efforts and tools to address this.
A health economic analysis is also included in the project to create a decision model for different dialysis methods. This model will be adapted to the conditions of different countries and used to prioritize interventions in home dialysis.
Our objective is that the solutions and strategies we develop should be integrated into national guidelines, influence nursing education and the companies' product development. The person-centered approach and framework we develop in home dialysis can also be applied in other areas of care.
Design thinking
HEALTH ECONOMIC MODEL
This activity aims to develop a health economic model adapted to the specific healthcare organizations and cost structures in Sweden, Denmark and Norway. The model is based on an earlier Norwegian model and must be updated with current data on healthcare costs, drug use and sickness absence for different dialysis methods. It also includes information from surveys on resource use and patient outcomes. Health economics researchers from the three countries will collaborate to create a basic model that will also be discussed with patient, healthcare and industry representatives. The goal is for the model to support sustainable decision-making, not only by showing the cost-effectiveness of different dialysis methods, but also how these affect different patient groups and other sectors of society, including environmental impact. Strategies from the project's other activities, such as a changed distribution chain and remote support, will be integrated and evaluated in the model. This provides a comprehensive economic evaluation and an adaptable model that can be used for future studies in the field of dialysis and extended to other areas such as kidney transplants. Participants include academic researchers, patient representatives, and healthcare and industry representatives from the three countries. They will also analyze environmental and financial gains related to reduced journeys for home dialysis, for example in the form of fewer hospital visits.
DEVELOPMENT / IMPROVEMENT
A preliminary study has shown that the identification of enablers is required to increase the use of home dialysis in the ÖKS regions in Denmark, Norway and Sweden. During the first year of the project, workshops will be held to find potential solutions. These solutions will then be tested practically in a home environment during the project's first three years using an iterative design methodology. In the third year, the most successful solution will be compared and evaluated against a control group. The project involves close collaboration with clinical operations, which is why a clinic coordinator is attached to the project in each country. The project's sub-activities include: Identification and practical testing of organizational and incentive-related barriers in healthcare providers, with cross-regional comparisons for cross-border learning. Analysis of communication needs and testing of solutions with healthcare providers and patients, including medical and technical aspects. Exploring information delivery to facilitate home dialysis choice, with practical tests of patients' perception of information. Thorough analysis of technical challenges in home dialysis monitoring and implementation, in collaboration with companies. Analysis of logistical challenges at home for home dialysis patients and development of strategies and technologies to improve logistics and waste management. Through these activities, the project aims to find and implement solutions to promote and improve home dialysis in the ÖKS regions.
SURVEY AND MAPPING
The project focuses on understanding why the development of home dialysis has stagnated over the past 30 years. A central part of the project is an extensive survey aimed at mapping factors that influence patients' choice of treatment methods. This survey, which is a core component of the project, is distributed to patients, care providers, decision makers and relevant companies in Sweden, Denmark and Norway. By analyzing the responses from these different groups and countries, we can identify both regional differences and similarities and gain a deeper understanding of barriers and opportunities for home dialysis. The survey will be designed and reviewed by representatives from each stakeholder group, and the results from these survey responses will form the basis for workshops and idea generation meetings using Design Thinking as a methodology. Patients, caregivers, decision makers and companies participate in these meetings to jointly find solutions and identify obstacles to home dialysis. The results from the survey are crucial to being able to carry out effective change work in the area of home dialysis. By understanding and addressing the factors that influence patients' choices, the project aims to create lasting changes and thereby increase the proportion of patients who use home dialysis. This project not only contributes to improved care and quality of life for patients, but also to more efficient use of healthcare resources.
ANALYSIS OF LEGISLATION, POLICY AND ACTION SYSTEMS
In this project, we will investigate the system-based prerequisites for home dialysis and the development of new person-centered innovations for this purpose. The goal is to identify obstacles within the home dialysis system and in the introduction of new innovations. This is done to promote person-centered home dialysis. The work includes four studies: A legal analysis of laws and policies affecting home dialysis and innovation in the field. A study of the processes for approval and implementation of home dialysis within different regions, with a focus on the Västra Götaland region. A similar study on the introduction of new medical technology solutions for home dialysis. Interview studies to identify barriers to home dialysis and innovations, as well as to understand different actors' views on these barriers. The results of these studies will be used in the overall design-thinking process and practical tests in a home environment. It is important to understand the legal limitations of potential solutions. The studies are carried out by partners with legal expertise and supported by a reference group of patient representatives and healthcare professionals. Expected outputs include legislative and policy analyses, mapping of home dialysis processes and innovations, and a compilation of barriers to home dialysis. The results will be presented in interim reports during the course of the project.
DEVELOPMENT AND TESTING OF INFORMATION STRATEGIES
This activity focuses on exploring and improving how information about home dialysis is delivered in Sweden, Denmark and Norway. The goal is to facilitate patients' choice of home dialysis by evaluating different types of information and communication methods. The aim is to provide clear and objective information about the dialysis options so that patients can make informed choices. Previous preliminary studies have shown that the information often does not get through in an efficient way. To remedy this, a group of patients, both experienced and new to home dialysis, together with healthcare staff, will develop and test information materials. This material will then be used in a clinic to see if it increases the percentage of patients who choose home dialysis, compared to a clinic that does not use the new material. In addition, the effect of experienced home dialysis patients' information to staff and new patients will be investigated. Experiences from this strategy, already tested in some countries, will be shared. Project partners include several universities, hospitals and companies, as well as patient associations and experienced patients. The project is coordinated by Aarhus University Hospital. Expected result is an optimized information strategy, both in content and form, to increase the number of patients who choose home dialysis.
DEVELOPMENT AND TESTING OF COMMUNICATION
This sub-project focuses on analyzing and testing communication needs and solutions to facilitate home dialysis. The study will be conducted in Sweden, Denmark and Norway and covers both medical and technical aspects of communication between patients and healthcare providers. The aim is to improve communication, which is crucial for patient safety, especially when it comes to having quick access to answers to medical and technical questions, as well as to ensure that any technical faults on the dialysis equipment can be detected and fixed quickly. The method includes identifying dialysis units and 3-5 home dialysis patients per country to test new communication solutions, including national services such as 1177 in Sweden. Idea generation sessions with patients, healthcare professionals and companies specializing in communication and dialysis equipment will be held. After that, potential solutions will be practically tested and evaluated for further implementation. Partners in the project include universities and hospitals in the three countries as well as companies such as Cuviva and Fresenius. Patient associations and experienced home dialysis patients also participate. Expected results are the identification, testing and development of optimal communication and monitoring solutions for home dialysis, contributing to the project's goal of improving home dialysis practice. The project is coordinated by Cuviva.
SUSTAINABLE MODEL FOR SELF-CARE AND HOME DIALYSIS
The project has, with the help of design thinking, created innovations and solutions that promote person-centered care and home dialysis. These solutions, developed through cross-border cooperation, are made available to patient organizations and the healthcare system. The aim is to develop a sustainable model for self-care and home dialysis, including strategies and action plans that facilitate informed decision-making and improve care for chronic kidney disease. The method includes compilation of factors from surveys and registry studies that influence the choice of home dialysis, as well as a legislative and policy analysis. Evaluation and prioritization of proposals for organizational models, gender equality, environment, information, purchasing routines, communication and logistics are done to facilitate home dialysis. A health economic analysis evaluates models and working methods. The project ends with a permanent cross-border 'Think Tank' to further develop the Scandinavian model for home dialysis. The final results are summarized in a report, and the project concludes with an international conference to discuss strategies and action plans to increase the use of home dialysis. Participants include the project's partners, patient organizations and health care decision makers.
DEVELOPMENT / IMPROVEMENT
A preliminary study has shown that the identification of enablers is required to increase the use of home dialysis in the ÖKS regions in Denmark, Norway and Sweden. During the first year of the project, workshops will be held to find potential solutions. These solutions will then be tested practically in a home environment during the project's first three years using an iterative design methodology. In the third year, the most successful solution will be compared and evaluated against a control group. The project involves close collaboration with clinical operations, which is why a clinic coordinator is attached to the project in each country. The project's sub-activities include: Identification and practical testing of organizational and incentive-related barriers in healthcare providers, with cross-regional comparisons for cross-border learning. Analysis of communication needs and testing of solutions with healthcare providers and patients, including medical and technical aspects. Exploring information delivery to facilitate home dialysis choice, with practical tests of patients' perception of information. Thorough analysis of technical challenges in home dialysis monitoring and implementation, in collaboration with companies. Analysis of logistical challenges at home for home dialysis patients and development of strategies and technologies to improve logistics and waste management. Through these activities, the project aims to find and implement solutions to promote and improve home dialysis in the ÖKS regions.
NATIONAL CHRONIC KIDNEY DISEASE AND DIALYSIS REGISTRY
The method is based on public data being compiled and analyzed from registers in America, Europe, Denmark, Sweden and Norway.