Five Year Experience of Concurrent Dialysis and Hospice: Outcomes and Perspectives

Outcomes 1. Describe two ways a concurrent hospice-dialysis program positively impacts end-of-life care for patients living with end-stage kidney disease.2. Identify three resources needed to implement effective concurrent hospice and dialysis care. Key Message Compared to the general Medicare population, patients on dialysis are half as likely to receive hospice. We developed a concurrent hospice-dialysis program for people living with end-stage kidney disease. Between 2018-2023, mean hospice length of stay for program enrollees was 14 days. 60% died in-home. In addition to policy changes, clinical implementation resources can facilitate scalable and equitable concurrent care. Introduction/Context Compared to the general Medicare population, patients on dialysis are half as likely to receive hospice. We developed a concurrent hospice-dialysis program to improve care for people living with end-stage kidney disease (ESKD). Objectives (1) to describe outcomes of a model of concurrent hospice and dialysis delivery, and (2) to develop a conceptual model of the Program, including key components, resources, and considerations for implementation. Methods We conducted chart reviews of utilization outcomes (N=51); a template analysis of qualitative interviews (N=39) with patients, family caregivers, hospice and dialysis clinicians, administrators and policy experts; and we convened a community advisory panel (CAP; N=19) to get feedback on current concurrent care delivery, design, and considerations for dissemination and implementation. Results Between 2018-2023, 52% of participants received ≥1 dialysis treatment; 48% received no dialysis. Mean hospice length of stay was 14 days (range 1-76). Mean dialysis treatments was 4.0 (range 1-10). Place of death was 60% at home, 21% inpatient hospice, and 12% nursing facility. Qualitative interviewees and CAP participants identified themes that define an effective model of concurrent hospice and dialysis: (1) timely goals-of-care conversations and (2) an interdisciplinary approach; (3) clear guidelines ensure smooth transitions for patients and families; (4) Hospice payment policy must support concurrent care. CAP participants provided feedback on the phases of an effective model of concurrent hospice and dialysis, and resources, including written and interactive educational materials, communication tools, workflow processes, order sets. Conclusion We developed a model for concurrent hospice and dialysis care and implementation materials. In addition to policy changes, clinical implementation and educational resources can facilitate scalable and equitable dissemination of concurrent care. Concurrent hospice and dialysis care must be systematically evaluated via a hybrid implementation-effectiveness trial that includes the resources outlined herein, based on our conceptual model of concurrent care delivery. Keywords Models of Palliative Care Delivery / Disease specific management