VA-Based Peritoneal Dialysis Program Feasibility Considerations and Process Outline

Abstract

Background: Home dialysis utilization is lower among veterans than in the general US population. Several sociodemographic factors and comorbidities contribute to peritoneal dialysis (PD) underutilization. In 2019, the Veterans Health Administration (VHA) Kidney Disease Program Office convened a PD workgroup to address this concern.

Observations: The PD workgroup was explicitly concerned by the limited availability of PD within the VHA, which frequently requires veterans to transition kidney disease care from US Department of Veterans Affairs medical centers (VAMCs) to non-VHA facilities when they progress from chronic kidney disease to end-stage kidney disease, causing fragmentation of care. Since the administrative requirements and infrastructure of VAMCs vary, the workgroup focused its deliberations on synthesizing a standard process for evaluating the feasibility and establishing a new PD program within any individual VAMC. A 3-phased approach was envisioned, beginning with ascertainment of prerequisites, leading to an examination of the clinical and financial feasibility through the process of data gathering and synthesis, culminating in a business plan that translates the previous 2 steps into an administrative document necessary for obtaining VHA approvals.

Conclusions: VAMCs can use the guide presented here to improve therapeutic options for veterans with kidney failure by establishing a new or restructured PD program.

FIGURE 1

VHA Dialysis Unit Locations Abbreviations: HD, hemodialysis; PD, peritoneal dialysis; VHA, Veterans Health Administration.

FIGURE 2

VHA Shared Decision Making for Dialysis Use Abbreviations: VHA, Veterans Health Administration; PD, peritoneal dialysis.

FIGURE 3

PD Program Business Plan Approval Process Abbreviations: ESKD, end-stage kidney disease; PD, peritoneal dialysis; VA, US Department of Veterans Affairs. ^aSupport team includes interventionists for PD catheter-related procedures, dietician, social worker, pharmacist, and administrative team at the local VA facilities involved in the approvals of the equipment and supplies.

FIGURE 4

Approval Process Overview for a New Peritoneal Dialysis Program Business Plan Abbreviations: CMO, chief medical officer; CoS, chief of staff; VISN, Veterans Integrated Services Network.