Quality Dialysis

Quality Dialysis provides staff-assisted home dialysis in the state of Texas, and has done so for over 14 years. Founded in 1993, the company’s mission is to educate patients and families about chronic kidney disease (CKD) while providing dialysis to patients in the comfort of their own homes.

Inspiration

Cindy Barclay, RN, the CEO of Quality Dialysis, was inspired to start the company when she realized that the chronic center was not the best solution for all patients. “There are patients who were trached who could not go to a dialysis facility. I thought, ‘We must provide another way,’ because they needed to be home with their families, and I didn’t think it was fair because dialysis centers didn’t allow patients who were trached to be home with their families,” she recalled.

“I had a reputation already in the medical community and the doctors knew me already and supported the project. It took about a year to get started, because of compliance issues with the home environment as well as ESRD. You have to know both entities, as far as Medicare is concerned. It’s a somewhat difficult program, because you have home health care on one side, and dialysis on the other side, and the twain have to meet,” she said.

But it’s not just dialysis on the menu; the company offers a “total package” of services, according to Barclay. “You have your nurse who goes out and dialyzes the patient three times a week, and a dietician and a social worker who visit on a monthly basis,” she explained.

In addition, there are also biomedical tech support services. These technicians service the machines on a monthly basis. If there are problems, the technician goes out and fixes the problem. Response time is relatively fast; technicians typically reach the patient’s home within 60 to 90 minutes, and the patient is able to undergo dialysis that same day.

Sometimes there are issues with the home’s water supply or with power, in which case the treatments are rescheduled until the problem is fixed. If the nurse has already gone on to her next appointment, a backup nurse from the main office can go out and provide the dialysis treatment.

Waste management is also handled by the company; the red bag waste from the patient’s treatments is picked up once a week by a contracted disposal company. The pickup time is scheduled around the patient’s preferences.

When patients begin dialysis, they receive other support, too, said Freemu Vargheese, MD, medical director of Quality Dialysis. In addition to regular visits from the dietician and social worker, there are also frequent phone calls to the patient regarding their progress and other problems coming up, he says.

Medicare assists with equipment and supplies, Barclay added. “It’s the same format as the chronic centers -- insurance covers it,” she said. “Patients use health insurance and Medicare, or can pay privately.”

Setup

The setup for staff-assisted home dialysis is surprisingly easy. Once the patient has been approved for home dialysis, the biomedical staff member does a home visit, and establishes that sufficient power is available to run the dialysis machine. After set-up, the technician will test the machine for power outages and related problems. If a dedicated line will be needed for the patient’s treatment, the tech can notify them, and the patient will often hire a private entity to install the line.

For the water supply, a special connector is attached to the patient’s faucet, and the hoses are connected via that attachment. All of the water for treatment is filtered through reverse osmosis and tested per AAMI guidelines for total chlorine/chloramine.

“The technician goes in and makes sure the electrical supply and outlets are well equipped for the machine. If not, we try to get them some new settings so they can hook up the machine. We also look at the room area and make sure the room is comfortable enough for the patient to dialyze there, and that the plumbing system is intact to get the water system hooked up,” Vargheese said.