How we did it: DaVita-Flint and DaVita-Southfield Dialysis at Home; Flint, Michigan, and Southfield, Michigan

A corporate commitment to offer more home dialysis options brought experienced dialysis nurse Linda Bodzin, RN, CNN, to DaVita-Southfield in March of 2004. In the newly-created position of Program Manager for DaVita at Home, Bodzin was charged with getting the home dialysis programs at two DaVita units up and running. Here's her story.

An exciting opportunity

At first, Bodzin was skeptical about starting two pilot home hemodialysis programs. "I had worked for years visiting dialysis facilities in several states as a PD Clinical Nurse Specialist with a product company, and I had seen home programs start up and then flounder without the right resources," she recalled. "The idea of starting home programs in two centers on my own was intimidating," she admitted.

What Bodzin learned at her job interview changed her mind. "There was tremendous support from DaVita," she said. "I was not going to be on my own at all, instead I'd be able to call on other DaVita centers with home programs for advice and support." She was also encouraged when she learned about the reasons that DaVita was making a corporate commitment to home dialysis. "They talked about 'doing the right thing' in terms of patient care and outcomes," recalled Bodzin, "and that conversation pulled me in."

In the end, she couldn't pass up the exciting opportunity to offer people who need dialysis more treatment options—especially home options. "Nothing compares to sending a hemo patient home," claimed Bodzin. "You're empowering them to have a better life, and I wanted to be part of that."

A quick start

Bodzin began working to set up the new home hemo programs when she joined DaVita in March 2004. Both the Flint and Southfield centers already offered PD, and Bodzin found that Davita's home-based experience was an asset. For example, Davita's PD Services Team's experience creating the existing PD manuals helped her team develop the home training procedures for hemo patients. "It was great to have a place to start," said Bodzin. "The PD manuals showed us how to 'dial down' our training language so that it was more patient friendly," she said.

The DaVita organization also gave Bodzin a running start with the certification application process. "Our preliminary goal was adding 2 new treatment options: traditional home hemodialysis and nocturnal in-center hemodialysis," remembered Bodzin. With the advice and support of DaVita at Home staff in other locations around the country, Flint and Southfield received their first certifications in just a few months.

It wasn't long before the DaVita-Flint center had its first referral for "nontraditional" dialysis. "We interviewed our first potential patient in April, 2004," reported Bodzin. "It was earlier than we'd planned, but the patient was doing poorly and the physician was anxious to try an alternative." Luckily, Bodzin and her team were nearly ready—and they started the patient on in-center nocturnal hemodialysis in May 2004.

A work in progress

Today, there are 15 patients doing nocturnal dialysis at the Flint center, and 11 patients doing hemo at home. The DaVita Southfield center serves 9 home patients. "We offer virtually every kind of home therapy now," noted Bodzin, "including PD, traditional hemo at home, nocturnal home hemo and—just recently—we've added short daily home hemodialysis."

To accommodate new therapy options, Bodzin and her team are continually updating the centers' policies and procedures. "We've got several different manuals that we are working on concurrently," claimed Bodzin. "We have a Training Manual that patients take home, a Facility Manual that outlines policies and procedures for home dialysis, and a Trainer's Manual that gives our staff instructions and tips for training patients.

It's a lot of work, and at every step Bodzin relies heavily on the advice and experience of her DaVita colleagues. "From the very start, I had weekly conference calls with my counterparts at other DaVita clinics with home programs," said Bodzin, "and we talked about every aspect of doing home dialysis." The weekly calls also included biomedical and laboratory staff. Although her two programs are up and running now, Bodzin still continues the weekly call routine. During the week, she writes down her questions and thoughts in preparation for the calls. "There's always something," she admitted, "there are a lot of things you just don't think about until you're doing them." Bodzin credits the smooth start-up of her two home programs to the ability to share information with the DaVita at Home team.

Ongoing challenge

Even though the two home dialysis programs are now established, maintaining and growing them provides an ongoing challenge. "From a clinical point of view the results are awesome," she noted, "home dialysis patients just do so well. To keep growing, however, we need to get more doctors on board."

Bodzin and her team work on getting the word out by making presentations to area nephrologists. She handles the clinical side of the home dialysis programs and the Davita at Home administration cover the business and insurance aspects. "The nephrologists who have experience with home dialysis from the 'old days' get really excited," said Bodzin, "because they've personally done it and have seen their patients' thrive." She admits that it's more difficult to convince younger nephrologists of the benefits. "They're familiar with in-center dialysis, and they're not always sure what they need to do to send patients home," she commented. "We try to show them how DaVita can help."

Ideally, Bodzin would like to double the size of both home programs. One way would be to see more early referrals so that patients can learn about their options and make the choice that is best for them before they start dialysis. If patients start dialysis on an emergency basis, they are usually too sick to consider all the options. Extra lead time would also help patients establish a working fistula and learn the buttonhole technique for cannulation, two things that Bodzin thinks make it easier to get started on home hemodialysis. "If we can talk to patients early on—even when they are stage 4—they are more open to home dialysis," claimed Bodzin. "Once they 'get stuck' on an in-center routine, they can be reluctant to make a change."

Worth the effort

Starting—and running— a home dialysis program with multiple treatment options takes considerable effort, but Bodzin thinks the results are worthwhile. From her experience, the critical elements that must be in place to succeed include: a support system, resources, commitment, and a dedicated team. Note: The DaVita at Home programs in Flint and Southfield have a training nurse, patient care technician, dietitian, and social worker assigned to home patients.

Excellent clinical results are what keep Bodzin committed to promoting home dialysis therapies and the DaVita at Home programs. "One patient called to tell me he dialyzed all night, worked all day, and then went bowling- and didn't feel tired! He was so excited, he had to let me know. That is just phenomenal for a dialysis patient."

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