Improving the "Conversion" Rate of Patients with Known Progressive CKD to Pre-Emptive Transplant Listing and Home Dialysis Options, a Two-Year Value in Health Care Project
Swansea Bay University Health Board
Introduction:
This two-year Value in Healthcare (ViHC) project aimed to reduce the number of undecided chronic kidney disease (CKD) patients (~30%) and improve conversion rates to pre-emptive transplant listing and home dialysis. It responded to low national rates in Wales and rising end-stage kidney disease (ESKD) cases.
Methods:
The CKD Education Team expanded from two part-time nurses to four full-time staff in January 2024. They redesigned patient education using the “three-talk model” (choice, options, decision) to replace the previous one-off, overwhelming session. The new format allowed multiple patient-centred interactions, delivered at home or in hospital, with time between sessions for reflection. New bilingual and multimedia materials (leaflets, animations, e-books) supported learning. Kidney workshops with peer mentors and clinical teams provided hands-on support.
Outcomes:
Quantitative data show significant progress: the percentage of “undecided” patients dropped from 26% in 2023 to 4% in 2024. There was an increase in patients expressing interest in pre-emptive transplant listing and home therapies. Eighteen-month follow-up data show more patients being listed and transplanted pre-emptively, and home dialysis (both PD and HD) uptake has increased. Patient questionnaires confirmed the new process is well-received and supports decision-making.
Learnings:
Team planning and unified commitment enabled rapid development and delivery. Strong recording, governance, and multidisciplinary collaboration were essential. While qualitative feedback and basic quantitative measures have been useful, earlier adoption of tools like PAM-13 would help measure patient engagement more robustly.
What Next?
The team is committed to sustaining and expanding the programme, pending continued ViHC funding post-2026. They aim to diversify materials (e.g. multilingual options), share findings nationally, and promote a replicable model for other services. The goal is a patient-centred, nationally consistent CKD education model improving clinical and economic outcomes.
