By Dr. Mihran Naljayan | Chief Medical Officer of Home Modalities
Studies show nephrologists experience a meaningful lack of exposure to home modalities during nephrology fellowships[i], and that can result in hesitance by nephrologists to prescribe home therapies for their patients. During my fellowship, I made a concerted effort to learn from experts in the field in order to enhance my understanding of home treatments, because I knew there were such transformative clinical benefits for dialysis patients treating at home. Even with greater focus on improving home modality education, there’s still a long way to go to remove these barriers.
As the chief medical officer of Home Modalities at DaVita Kidney Care, I see opportunity to close these gaps by presenting clinical care teams with needed information to help them determine if a home modality is possible, recommended or clinically beneficial to a patient, and to make sure they have that information where it matters most—at the point of care.
In August 2022, DaVita introduced a new feature—Point of Care Clinical Support (POCCS)—to its OneView platform (a tool for providers and their practice teams to manage the holistic care of kidney disease patients). This tool is embedded into a physician’s workflow and provides patient-specific guidance at the moment of treatment.
Typically, if a physician wants to find the International Society for Peritoneal Dialysis (ISPD) guidelines on peritonitis management, the process is disjointed and they’d have to search for information in various locations. They would need to open up a web browser in the middle of their workflow, navigate to the guidelines page on the ISPD website, then search for peritonitis and locate the information they need. With POCCS, OneView can identify whether or not a patient is currently diagnosed with peritonitis and present needed information to nephrologists with the appropriate guideline-based treatment recommendations – all in one place.
Having such information at a nephrologists’ fingertips is powerful. Here’s an example: When a patient of mine was recently hospitalized, an alert popped up showing me a one-pager on how to prevent hospital readmission and help the patient remain on their modality of choice post-hospitalization. The alert appeared before the nurse notified me the patient had been hospitalized. So, I contacted the nurse to ask why the patient was hospitalized and how to best manage their transition back to outpatient care. POCCS allowed me to be proactive rather than reactive to my patient’s care.
When it comes to providing our clinicians with relevant, up-to-date clinical information, we’re already observing clear examples of how POCCS provides support.
Two clinical teammates (DaVita employees) and a physician recently inquired about how to treat calciphylaxis (a disease in which calcium accumulates in small blood vessels of the fat and skin tissues) in a PD patient without having to administer intravenous sodium thiosulfate. With POCCS, OneView identifies terms in the encounter note consistent with calciphylaxis and assists the provider in locating clinical guidance on the issue. The physician simply needs to click the light bulb that populates in the interface.
But education isn’t the only benefit of POCCS.
Throughout my years of experience as a nephrologist, clinical burnout has consistently been on the rise. Recent research not only shows high levels of burnout among the health care workforce, but also indicates burnout is prevalent among nephrology trainees and practicing nephrologists.[ii]
By creating education and informational opportunities within the OneView platform, POCCS helps reduce the time and energy needed to find critical information that helps inform care decisions, especially when considering prescription management, preventing modality loss and strategies that empower patients to make informed choices about their modality and treatment options.
While nothing can replace a great nurse and interdisciplinary team, technology like POCCS can help patients and care teams in many ways. These tools can enhance clinical care to help keep patients out of the hospital and on their modality of choice longer, as long as clinically appropriate, while supporting nephrologists to practice evidence-based medicine at the point of care.
Over time, this feature can be expanded to in-center hemodialysis to improve the continuum of care across all stages of kidney disease and modalities.
Ultimately, we’re hoping to reduce the burden on less experienced physicians and be able to provide educational resources right at their fingertips, building their confidence as they care for home patients, and allowing them to achieve better clinical outcomes for patients on home therapies who are willing and capable of treating at home.
Disclaimer: Service provider and modality selection are choices made exclusively between the patient and nephrologist. POCCS is intended to be a guide and is not intended to replace the nephrologist's medical judgment. DaVita does not prescribe treatment type, frequency, or medications, and defers to the nephrologist to prescribe on a patient by patient basis.
[i] Gupta N, Taber-Hight EB, Miller BW. Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows. Am J Kidney Dis. 2021 May;77(5):713-718.e1.
[ii] Nair D, Brereton L, Hoge C, Plantinga LC, Agrawal V, Soman SS, Choi MJ, Jaar BG; National Kidney Foundation Education Committee. Burnout Among Nephrologists in the United States: A Survey Study. Kidney Med. 2022 Jan 12;4(3):100407. doi: 10.1016/j.xkme.2022.100407. PMID: 35386610; PMCID: PMC8978053.