title: Systematic barriers to the effective delivery of home dialysis in the United States: a report from the Public Policy/Advocacy Committee of the North American Chapter of the International Society for Peritoneal Dialysis.
abstract: Home dialysis, currently underused in the United States compared with other industrialized countries, likely will benefit from the newly implemented US prospective payment system. Not only is home dialysis less expensive from the standpoint of pure dialysis costs, but overall health system costs may be decreased by more subtle benefits, such as reduced transportation. However, many systematic barriers exist to the successful delivery of home dialysis. We organized these barriers into the categories of educational barriers (patient and providers), governmental/regulatory barriers (state and federal), and barriers specifically related to the philosophies and business practices of dialysis providers (eg, staffing, pharmacies, supplies, space, continuous quality improvement practices, and independence). All stakeholders share the goal of delivering home dialysis therapies in the most cost- and clinically effective and least problematic manner. Identification and recognition of such barriers is the first step. In addition, we have suggested action plans to stimulate the kidney community to find even better solutions so that collectively we may overcome these barriers.
authors: Vanderbilt University, Nashville, TN 37232, USA. thomas.golper@vanderbilt.edu
authors: Thomas A
authors: TA
authors: Golper
authors: Anjali B
authors: AB
authors: Saxena
authors: Beth
authors: B
authors: Piraino
authors: Isaac
authors: I
authors: Teitelbaum
authors: John
authors: J
authors: Burkart
authors: Fredric O
authors: FO
authors: Finkelstein
authors: Ali
authors: A
authors: Abu-Alfa
mesh_terms: D000068:Accreditation; D006297:Health Services Accessibility / Q000458:organization & administration*; D006437:Hemodialysis, Home / Q000191:economics / Q000193:education / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D006278:Medicare / Q000191:economics; D009398:Nephrology / Q000193:education; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis; D011445:Prospective Payment System; D017749:Total Quality Management; D014481:United States