Background: The transition from choosing to initiating HDTs is not clearly defined or standardized for patients and staff. This may cause increased anxiety and unaddressed self-management for CKD patients, and lack of confidence in staff who support them. These factors may also lead to delays in transition. To address some of these concerns at BC Renal, a “Transition to HDTs” guidebook (the Guide) was designed, outlining a step-wise approach to transitioning to HDTs for patients. Assessment of this intervention required a structured and practical evaluation strategy.
 
Objectives: We used the Logic Model evaluation framework (Figure 1) to assess whether having the Guide can improve patient and staff experience with transitioning to HDTs.
 
Methods:  The study ran over a 6-month period at 2 pilot and 3 control sites. The intervention strategies included: 1)Training of front-line staff to use the Guide and 2)Dissemination of the Guide to patients. Evaluation tools measuring data at baseline and at the 6-month point include: 1)Qualitative patient interviews, 2)Quantitative patient surveys, 3)Qualitative staff surveys, 4)Structured feedback session with renal care staff, and 5)Documented transition time between choosing and starting PD.
 
Outcomes: 43 patients were enrolled in the pilot sites; 9 completed the study (6 PD and 3 HHD). Transition time was improved in pilot vs. control (54.4 vs. 73 days). Patients’ anxiety, illness knowledge, and activation of resources improved after PD/HHD training at both pilot and control sites. During interviews, patients confirmed that the Guide was effective and helped retain knowledge. The staff felt that the intervention did not increase their workload and that the Guide was a good communication tool, but used inconsistently.
 
Conclusion: We present a systematic framework to evaluate a multi-intervention strategy to improve patients’ transition to HDTs, which may be applicable to other complex healthcare initiatives. The Guide may help reduce transition time while improving patient anxiety and illness knowledge through enhanced communication between patients and health care providers. Future work is required to standardize the Guide’s utilization.

Using a Logic Model to systematically evaluate an initiative to improve patient transition to home dialysis therapies (HDTs)