Using the MATCH-D More Effectively to Increase Utilization of Home Therapies
With CMS’s stated intent to see 80% of new End Stage Kidney Disease (ESKD) patients either receive a preemptive transplant or start treatment on a home modality, there’s growing interest among policymakers in increasing utilization of home modalities in the United States. A significant barrier to home utilization is lack of education among some patients, dialysis clinic staff, and physicians regarding candidacy for home treatment.*
There are several tools that have been developed to help educate care providers on how to identify patients who may be eligible to treat on a home modality. One of those tools is the Medical Education Institute’s Method to Assess Treatment Choices for Home Dialysis (MATCH-D) framework—which uses a green/yellow/red schema to identify patient characteristics relevant to home modality eligibility. DaVita has found the MATCH-D to be particularly effective in helping clinicians to identify and address patient eligibility in a standardized and consistent way. We actively use this framework at our 2,500 in-center hemodialysis clinics across the country to support and empower active, informed patient therapy choice.
Still, my observation has been that—even where we have experience utilizing the MATCH-D framework—there’s still opportunity to improve the effectiveness of how we use the tool. As I interact with our teams across the United States, I emphasize three points I have found to be important in using MATCH-D effectively:
1. The assessment framework is for self-treatment. It is important to read the sub-heading on the MATCH-D worksheet: “Suitability criteria for Self Peritoneal Dialysis (PD) [and Home Hemodialysis (HHD)].” The word “self” has two important implications. First, particularly for PD, it is possible for some patients to successfully perform dialysis without a care partner. In other words, lack of a care partner is not necessarily a contraindication. Second, if the patient does have a care partner, this alone may be sufficient to address some potential barriers (e.g., patient cognitive impairment).
2. Patients with “yellow” characteristics are often very strong candidates for home dialysis. It is important to focus enhanced attention not only on patients with all “green” characteristics, but also patients with “yellow” characteristics. Some yellow characteristics are perceived barriers and are only included for purposes of calling out that they are not necessarily barriers to home dialysis (e.g., socioeconomic status and simple abdominal surgeries). Others are often easily addressable through coaching (e.g., instructing patients with pets to remove them from the room during connect and disconnect procedures). Still others can often be readily addressed by experienced clinicians (e.g., use of a presternal PD catheter for an obese patient). Patients with yellow characteristics may desire and be able to transition to home as quickly as patients with all green characteristics. A delay in a patient transition to home may negatively impact patients who are trying to maintain employment or preserve residual kidney function.
3. Those interacting with physicians and patients should know each characteristic on the MATCH-D framework. It is important to continue to educate physicians and dialysis clinic staff on characteristics that are noted as addressable by the MATCH-D framework. For example, patients who swim, have pets, are obese, or have visual impairment—all characteristics noted as addressable by the MATCH-D framework—may still be able to successfully perform a home therapy. It’s especially important to provide this education to individuals who have been using the MATCH-D to perform patient assessments. My observation has been that many potential home therapy education gaps are addressed by the MATCH-D. Those well-versed
in the framework could be in a better position to appropriately and effectively bring those considerations into conversations with patients, physicians, and other clinicians.
In my opinion, the MATCH-D is one of the most effective resources for promoting greater awareness regarding eligibility for home therapies. When used well, this framework can potentially meaningfully increase the rate of home adoption. Of course, modality choice is always a shared decision made between a patient and their physician. Our role as dialysis providers is to offer education and support such that the patient is empowered to make an active, informed choice as they discuss options with their physician. In support of our provider role, if home therapy education gaps are identified, clinic staff can directly confront such issues by providing their own clinical expertise and also noting that, “the MATCH-D suggests that this may not be a barrier or is addressable. Here’s what the text says. Can we talk about it further?” Then, as needed, bring other experienced clinicians into the conversation who can talk with the physician and patient about the patient’s specific circumstances.
As CMS has suggested, many more patients may be better served by being on a home modality, and I am convinced that the MATCH-D will continue to play a meaningful role in helping the dialysis community achieve that aim. I’m excited about where we’re headed as a community and look forward to seeing the profound impact home modalities will continue to have on patient care and quality of life.
*Service provider and modality selection are choices made exclusively between the patient and nephrologist.