Transforming Kidney Health: The Role of Nursing Leadership in Value-Based Care.

This article examines the critical role of nursing leadership in the transition of nephrology care toward value-based models, highlighting how interdisciplinary care teams and population health management strategies are instrumental in improving patient outcomes and achieving health equity in kidney care. By reviewing both historical and present value-based care models in nephrology, this article showcases the evolution of care delivery and the strategic alignment of health care practices with value-based objectives. We introduce "HEALTH" as an innovative blueprint for nephrology nursing leadership, encapsulating key strategies to enhance kidney health care within the framework of value-based models. The acronym HEALTH stands for Holistic Care Integration, Equity and Tailored Care, Analytics and Machine Learning, Leverage Federal Programs, Training and Education, and Habit of Improvement, each representing a cornerstone in the strategic approach to advancing nephrology care. Through this lens, we discuss the impact of nursing leadership in fostering a culture of continuous improvement, leveraging technological advancements, and advocating for comprehensive and equitable patient care. This article aims to provide a roadmap for nursing leaders in nephrology to navigate the complexities of health care delivery, ensuring high-quality, cost-effective care that addresses the needs of a diverse patient population.

Integrating Care Coordination and Mental Health Research Into Dialysis Practice: Stakeholder Perspectives, Methods, and Outcomes.

Rationale & Objective: Despite many studies suggesting beneficial innovations for patients, few make it into clinical practice. This study aims to enhance patient care by facilitating effective dissemination of patient-centered outcomes research to health care workers in outpatient dialysis facilities, aided by the Patient-Centered Outcomes Research Institute's (PCORI) dissemination and implementation framework. Study Design: Dissemination and implementation project. Setting & Population: Outpatient hemodialysis facilities in the United States. Methods: We brought together panels of key stakeholders, which included researchers, patient subject matter experts, and dialysis personnel. Their role was to provide guidance on the content and methods for disseminating research findings. With a focus on 2 critical patient safety areas-care coordination or care transitions and mental or behavioral health-we developed virtual education modules. These modules were then made available to outpatient dialysis facilities by the national 5-Diamond Patient Safety Program. Results: In 2022, the training was used by more than 2,500 dialysis facilities and approximately 40,000 dialysis staff in the care coordination module, and by more than 300 dialysis facilities and 5,000 staff for the mental health module. Cumulatively, the modules affected more than 179,000 patients. Evidence of efficacy was the significant increase in trainee knowledge of research findings and implementation considerations (P ≤ 0.05). Limitations: Potential selection bias because dialysis facilities that did not participate in the program may differ significantly from those that did, which may affect generalizability. In addition, variable timing in release of the different modules may have influenced uptake by facilities. Conclusions: By using key stakeholder guidance and accessible virtual education modules, the implementation framework shows promise in effectively disseminating research findings within outpatient dialysis settings. This method potentially carries implications for broader health care settings as well. Plain-Language Summary: Our study addresses a common health care challenge-many promising ideas for improving patient care never actually reach the patients. We aimed to bridge the dissemination gap by sharing research with health care workers in outpatient dialysis, promoting evidence-based practice. We collaborated with experts, patients, and dialysis personnel to develop easy-to-understand educational materials focused on 2 critical topics: care coordination and mental health. In 2022, our training benefited more than 2,500 facilities and 40,000 staff for care coordination, and 300 facilities with 5,000 staff for mental health, positively affecting more than 179,000 patients. We found that the training significantly increased knowledge among staff. Our approach shows promise for sharing research effectively in dialysis centers and potentially in other health care settings.

Loneliness and Burnout in Nephrology Nurses: A Review of the Literature and Indications for Future Research.

Nurses are crucial to the health care workforce, yet their well-being is often overlooked, adversely affecting patient care. This article examines the intersection of loneliness and burnout among nephrology nurses, and its impact on their well-being and job performance. Loneliness, defined as inadequate social connections, is identified as a significant contributor to burnout and suboptimal well-being among nurses. Findings emphasize the importance of addressing loneliness and promoting social connectedness within the nursing profession. Strategies, such as fostering supportive relationships, creating support groups, and implementing policies to reduce emotional burdens and workload pressures, are recommended. We emphasize the need to prioritize nurse well-being for a resilient health care workforce and improved patient outcomes, and discuss its implications for nursing practice, education, and policy.

Exploring the Evidence: Considerations for the Dialysis Practice Setting Approach to Staffing.

Nursing remains one of the most in-demand jobs in the American workforce. The impact of the COVID-19 pandemic has created strain on nursing resources throughout the health care industry and drawn attention to longstanding workforce issues. Inadequate staffing is often a multidimensional problem that warrants a comprehensive assessment of elements that may contribute to recruitment and retention issues. In the dialysis practice setting, nursing shortages remain an ongoing issue due to an aging workforce and ongoing issues for recruiting nurses both new and skilled into the field of nephrology. This article explores the evidence on approaches to staffing in the dialysis practice setting by defining core elements to consider when designing a staffing model. These elements include federal/state regulations, patient acuity, staff ratios, workforce perceptions, patient outcomes, and dialysis modalities offered.

Research and Quality Improvement: How Can They Work Together?

Research and quality improvement provide a mechanism to support the advancement of knowledge, and to evaluate and learn from experience. The focus of research is to contribute to developing knowledge or gather evidence for theories in a field of study, whereas the focus of quality improvement is to standardize processes and reduce variation to improve outcomes for patients and health care organizations. Both methods of inquiry broaden our knowledge through the generation of new information and the application of findings to practice. This article in the "Exploring the Evidence: Focusing on the Fundamentals" series provides nephrology nurses with basic information related to the role of research and quality improvement projects, as well as some examples of ways in which they have been used together to advance clinical knowledge and improve patient outcomes.

Patient Peer-to-Peer Mentoring for Patients with Kidney Failure: Methods, Facilitators, and Lessons Learned.

Prior research among patients with kidney failure has found peer mentoring to be an effective strategy for improving patient outcomes. However, a gap remains in understanding how peer mentoring can be utilized to support a patient's decision-making in choosing a kidney replacement treatment modality. Quality Insights, Inc., has developed and implemented a patient advocacy program (PAP) to support patients in choosing home dialysis as a treatment option and pursuing kidney transplant through waitlisting. Mentors, known as patient advocates, follow a three-step process that includes peer-to-peer mentor training, developing a patient testimonial, and integration into the quality improvement team. The PAP has increased interest among in-center patients on hemodialysis considering home dialysis or kidney transplant. Additionally, barriers, facilitators, and lessons learned have been identified in supporting a patient peer-to-peer mentoring program.

Implications of the End-Stage Renal Disease Treatment Choices Model among U.S. Dialysis Providers.

The End Stage Renal Disease Treatment Choices (ETC) Model is a mandatory payment model designed to encourage greater use of home dialysis and kidney transplantation among Medicare beneficiaries with kidney failure and to reduce Medicare expenditures while enhancing the quality of care offered to patients with kidney failure. The ETC model will run for six years, from January 1, 2021, to June 30, 2027. This article provides an overview of the ETC Model and analyzes its implications for dialysis providers.