Over the past 20 years, health care as a whole has been moving toward the patient-centered care-end of the spectrum. What’s the next step? Care that is truly delivered by patients themselves.” In the dialysis unit, staff members can promote patient self-management techniques, from hand washing to self-cannulation and self-management.   A recent Harvard Business Review article,  The Value of Teaching Patients to Administer Their Own Care, includes an example of a self-care dialysis program at the Central Texas Nephrology Associates (CTNA) clinic in Waco, Texas.  Below are a few excerpts from the article, and links to videos and additional information on the Institute for Healthcare Improvement’s website, http://www.ihi.org.

• “In 2016, nearly 40% of CTNA’s 751 patients performed their own dialysis while experiencing fewer hospitalizations and a lower mortality rate than patients receiving dialysis the conventional way.  Patients delivering their own dialysis experienced better outcomes and the health system minimized costs by avoiding unnecessary hospital visits.”
• “Providers’ role changed from performing every step of the process to serving as coaches and supporters of patients doing their own care.  The resulting redeployment of staff resources led to higher productivity throughout the clinic.”

Regardless of the setting, a successful approach to patient-administered self-care requires the following :

• “Patients (or caregivers…) must be prepared and willing… Care organizations need to develop a standard process for training patients… Practitioners must be trained to support patient-administered care … to see themselves as coaches and the patient as an integral partner. …[to] recognize that patients’ capabilities to provide their own care may differ and evolve over time, and …to connect with the patient…”
• “A standard protocol should be developed [including] …methods for distributing equipment, supplies, and medication … [and] how patients and providers should respond to adverse events. …easy access to outpatient and inpatient services to address any needs that arise.”
• “A care organization that has a value-based-payment system will have a much easier time adopting the self-care model …Patient-administered care realizes savings by avoiding spending in the first place; in a fee-for-service model, this is lost revenue.”