Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Setting Up a Person-Centered Home Dialysis Program

Video Transcription

Video Summary

Dr. Graham Abra discusses how to build a person-centered home dialysis program, drawing on experience overseeing dozens of PD and home hemodialysis (HHD) programs. Home dialysis use in the U.S. has grown (mainly automated peritoneal dialysis), but the U.S. still lags many peer countries in the proportion of patients treated at home. Many U.S. dialysis centers either don’t offer home therapies or have very small home censuses, especially for HHD.<br /><br />He outlines reasons to start a program: patient-centered benefits, policy/payment incentives emphasizing home therapies, filling gaps in underserved areas, or improving quality beyond existing local options. Key early decisions include whether to build independently or partner with an organization—balancing control and potential profit against required expertise, scale, capital, and operational burden.<br /><br />Abra emphasizes market assessment (population size/trends, staffing availability, payer mix, referral sources, and alignment with in-center units for respite and transitions). Core business needs include contracting/billing, procurement, IT/EMR, marketing, regulatory compliance, and financial pro formas.<br /><br />Operational success depends on thoughtful location and facility design (training-focused space), a strong education program to increase home modality uptake, and a high-performing interdisciplinary team with standardized protocols, robust training, home assessments, and a continuous quality improvement (QAPI) program. He closes by highlighting add-on programs (urgent-start PD, transitional care, assisted dialysis, respite, peer mentoring) to address common clinical and psychosocial challenges. A Q&A raises barriers like non-competes and staffing competition, suggesting management-fee models to expand access.

Asset Subtitle

Graham Abra

Meta Tag

Module DIAL

Speaker Graham Abra

Keywords

person-centered home dialysis program

peritoneal dialysis (PD)

home hemodialysis (HHD)

market assessment and payer mix

staffing and interdisciplinary team training

regulatory compliance and QAPI continuous quality improvement

urgent-start PD and transitional care add-on services