Veterans Health Administration Peritoneal Dialysis Program Infrastructure and Clinical Practices: Findings from a Nationwide Questionnaire

Peritoneal dialysis (PD) use among the United States (US) Veteran population is lower than that in the non-Veteran kidney failure population. Increasing choice of and access to high quality home dialysis within the Veteran population is a Veteran Healthcare Administration (VHA) strategic priority. To date, no comprehensive assessment of existing VHA PD programs has been conducted. The VHA Peritoneal Dialysis Committee conducted a nationwide stakeholders survey to inform strategies to improve Veterans ability to select PD (VHA PD Choice subgroup), 2) to access PD (VHA PD Access subgroup), and 3) to receive excellent quality PD (VHA PD Quality subgroup). This manuscript reports findings from the PD quality and respondent characteristic survey items, which were designed to assess current infrastructure and clinical practices for VHA PD services. Participants were invited by email and completed an electronic questionnaire. A total of 27 VHA PD programs responded to the survey (100% response proportion) with a median number of 10 patients. Facility-level variation was found in PD infrastructure and clinical practices, which include differences in services to PD patients, training and staffing ratios for PD nurses, and clinical practices for initiation and maintenance of PD. Large PD programs (more than 10 Veterans) offered a broader range of services (e.g., outpatient and inpatient PD, urgent-start PD) and reported greater alignment with PD clinical practice guidelines than small PD programs (less than 10 Veterans). Substantial variability exists in PD infrastructure and clinical practices within VHA, especially in comparisons of small versus large PD programs. Program-aligned facility infrastructure, standardized best clinical practices, and quality assessment and improvement initiatives have already begun to increase successful utilization of PD across VHA.