The Pathways Project
Changing the culture of kidney care to a more patient-centered approach
The Pathways Project is leading change in the use of supportive (palliative) care for patients with kidney disease. Currently, in the United States, the fastest-growing population of patients receiving dialysis is older than 75 years. These patients may be frail or have two or more chronic diseases in addition to kidney disease, and dialysis may reduce their quality of life and not improve their survival. The Pathways Project is working to transform kidney care for this population so that it aligns with patient values, preferences, and goals. It seeks to improve the overall quality of life and help people who want to be home at the end of life do so. It offers the option of medical management without dialysis for those who prefer this approach. The overall aim of the Pathways Project is to assist clinicians caring for patients with kidney disease to provide patient-centered care. The Pathways Project is leading change in the use of supportive (palliative) care for patients with kidney disease. Currently, in the United States, the fast-growing population of patients receiving dialysis is older than 75 years. These older patients may be frail or sick with two or more chronic diseases, and dialysis may not extend their life and may reduce their quality of life. The Pathways Project is working to transform kidney care for this population so that it lines up with patient goals, improves the overall quality of life and helps people stay home near the end of life if that is their choice. This includes providing the option of comprehensive medical care without dialysis for patients who prefer this approach. The overall aim is to provide patient-centered care that aligns with patient goals.
The Pathways Project developed a change package with 14 evidence-based best practice recommendations designed to improve supportive care delivery for patients with kidney disease. The ideal care system for seriously ill patients with kidney disease was defined. In this ideal patient-centered system:
- Patient preferences, goals, and values are elicited and respected,
- Patients receive treatment aligned with their goals, and
- Patients and families receive the support, resources, and assistance to help them prepare for end-of-life care.
Over the next two years, the Pathway Project will collaborate with approximately 15 dialysis organizations across the United States to implement supportive (palliative) care practices within dialysis centers and their affiliated nephrology practices. Providers and organizations in the Pathway Project Collaborative will be given the tools, training, and resources to help them put supportive care into practice.
Funding the project
The Pathways Project is funded by the Gordon and Betty Moore Foundation. The Gordon and Betty Moore Foundation fosters path-breaking scientific discovery, environmental conservation, patient care improvements and preservation of the special character of the Bay Area. Visit Moore.org and follow @MooreFound.
To further this goal, the Foundation awarded funds in 2016 to Quality Insights to launch the Pathways Project. In this first phase, the Pathways team conducted a literature search, consulted with a Technical Expert Panel, interviewed innovators in supportive kidney care, and used the resulting information to develop a comprehensive resource for implementing supportive kidney care.
The second phase of the Pathways Project focuses on the implementation of best practices. The second phase is based at George Washington University School of Nursing in Washington, DC, in collaboration with West Virginia University.
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