Pathways Project Pragmatic Lessons Learned: Integrating Supportive Care Best Practices into Real-World Kidney Care

Document Type

Journal Article

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BACKGROUND: Despite two decades of national and international guidelines urging greater availability of kidney supportive care, uptake in the US has been slow. We conducted a multi-site quality improvement project with ten US dialysis centers to foster implementation of three kidney supportive care best practices. This article shares pragmatic lessons learned by the project organizers. METHODS: The project team engaged in reflection to distill key lessons about what did or did not work in implementing kidney supportive care. RESULTS: The seven key lessons are 1) systematically assess kidney supportive care needs, 2) prioritize both the initial practices to be implemented and the patients who have the most urgent needs, 3) use a multi-faceted approach to bolster communication skills, including in-person role modeling and mentoring, 4) empower nurse practitioners and social workers to conduct advance care planning through teamwork and warm handoffs, 5) provide tailored technical assistance to help sites improve documentation and electronic health record processes for storing advance care planning information, 6) coach dialysis centers in how to use required Quality Assurance and Performance Improvement processes to improve kidney supportive care, and 7) implement systematic approaches to support patients who choose active medical management without dialysis. CONCLUSIONS: Treatment of patients with kidney disease is provided in a complex system, especially when considered across the continuum, from chronic kidney disease to kidney failure on dialysis, and at the end-of-life. Even among enthusiastic early adopters of kidney supportive care, 18 months was insufficient time to implement the three prioritized kidney supportive care best practices. Concentrating on a few key practices helped teams focus and see progress in targeted areas. However, impact for patients was attenuated because federal policy and financial incentives are not aligned with kidney supportive care best practices and goals.


Nursing Faculty Publications