The impact of the Starting dialysis on Time, At home on the Right Therapy (START) project on the use of peritoneal dialysis.

Background: Peritoneal dialysis (PD) is actively promoted, but increasing PD utilisation is difficult. The objective of this study was to determine if the Starting dialysis on Time, At Home, on the Right Therapy (START) project was associated with an increase in the proportion of dialysis patients receiving PD within 6 months of starting therapy.
Methods: Consecutive patients over age 18, with end-stage kidney failure, who started dialysis between 1 April 2015 and 31 March 2018 in the province of Alberta, Canada. Programmes were provided with high-quality data about the individual steps in the process of care that drive PD utilisation that were used to identify problem areas, design and implement interventions to address them, and then evaluate whether those interventions had impact. The primary outcome was the proportion of patients receiving PD within 6 months of starting dialysis. Secondary outcomes included hospitalisation, death or probability of transfer to haemodialysis (HD). Interrupted time series methodology was used to evaluate the impact of the quality improvement initiative on the primary and secondary outcomes.
Results: A total of 1962 patients started dialysis during the study period. Twenty-seven per cent of incident patients received PD at baseline, and there was a 5.4% (95% confidence interval: 1.5-9.2) increase in the use of PD in the province immediately after implementation. There were no changes in the rates of hospitalisation, death or probability of transfer to HD after the introduction of START.
Conclusions: The approach used in the START project was associated with an increase in the use of PD in a setting with high baseline utilisation.
Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This study is based in part on data provided by Alberta Health and Alberta Health Services. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta or Alberta Health Services. Neither the Government of Alberta, nor Alberta Health or Alberta Health Services express any opinion in relation to this study. Dr Rob Quinn is the co-inventor of the DMAR™ System and is the co-owner of the intellectual property associated with it. He has received speaking fees and attended advisory boards for Baxter Healthcare Corporation. Dr Matthew Oliver is co-inventor of the DMAR™ System. He received speaking fees from Baxter Healthcare. He has attended advisory boards for Janssen and Amgen. Dr Scott Klarenbach is Director of the Real World Evidence Consortium, and Alberta Drug and Therapeutic Evaluation Consortium (Universities of Alberta, Calgary, and Institute of Health Economics); these entities receive funding from decision-makers and industry to conduct research. All research funding is made to the academic institution; investigator retains full rights of academic freedom and right to publish. This relationship is not related to the current work. He was supported by the Kidney Health Research Chair and the Division of Nephrology at the University of Alberta. Dr Nairne Scott-Douglas has received speaking fees and attended advisory boards for Bayer, Boehringer Ingelheim and Astra Zeneca and attended Advisory Boards Janssen, Amgen and Otsuka. Dr Robert Pauly, Dr Braden Manns, Danielle Fox, Anita Kozinski, Farah Mohamed, Louise Morrin, Tracy Schwartz and Alix Clarke have no relevant disclosures.