Episode 30: Innovative Educational Experiences for Patients with Michelle Carver, VP of Clinical Services Initiatives
Training and education is absolutely critical to helping patients feel confident in their choice of home dialysis. Michelle Carver, Vice President of Clinical Services Initiatives, joins Field Notes to discuss two new educational experiences that are comprehensive, fully customizable for each patient, and are rapidly gaining popularity.

Brad Puffer: Welcome everyone to this episode of Field Notes, I’m Brad Puffer on the Medical Office communications team at Fresenius Medical Care North America and your host for this discussion today. Here we interview the experts, researchers, physicians, and caregivers who bring experience, compassion, and insight into the work we do every day. As we work to expand access and help more people feel confident in choosing home dialysis, we understand that the transition to home treatment and learning to perform dialysis on one's own can be intimidating at first. That's why good training and support during the first few weeks and months are so critical to long term success. To help, Fresenius Kidney Care has launched a home dialysis digital training platform with two separate educational experiences for both peritoneal dialysis and home hemodialysis. Both experiences provide a new comprehensive educational program that is fully customizable for each patient. It's an extra tool that patients have access to all the time, even after their in-person training with the nurse. So far, the new platform is taking off in popularity and winning awards. Michelle Carver, Vice President of Clinical Services Initiatives, joins Field Notes now to explain how these educational experiences can help patients be successful at home. Michelle, welcome to Field Notes. 

Michelle Carver: Thanks, Brad. I'm excited to be here, and I really appreciate the opportunity to share more information about the new PD Education Experience.

Brad Puffer: Well, we appreciate you being here because we know you were at the ground getting this going and making sure we had even better support for patients at home. I know we launched the PD education experience back in 2021, first as a pilot and then really expanded it and it took off. Why was this such an important project for us, and what need did it fill? 

Michelle Carver: Fresenius has a goal to offer as many patients the option of home dialysis as possible. So, one of the big reasons why we wanted to create a training plan for patients is to expand the population of patients that might have interest in doing some home modality in the future. And one of the needs that we really wanted to fill was providing a one stop shop for training materials for the patients when they're initially learning the modality. It not only afforded patients an opportunity to have everything at their fingertips, but it also provided our clinical care teams the materials in one place so that they didn't have to gather a bunch of things to conduct training initially. 

Brad Puffer: Maybe you can take a second just to describe what this looks and feels like for a patient. It's not just taking, you know, training materials and words on paper onto a digital platform. It's more than that, right? 

Michelle Carver: One of the things about a digital platform is we're able to build in some interactive functionality for patients. So, instead of just reading flat content, there are some games that we embed in some of the modules of education. So, for example, there are some drag and drop, where we have them answer some questions. There's also the ability to do some matching. We also have included videos and some other interactive tools to make training a little bit different and break up just the flat content of reading information being delivered to them. 

Brad Puffer: Well, I want to go back to the creation of this. That is super exciting and now I can clearly see how this might work. How exciting was it for you to be at the table early on helping lead the creation of this new training platform? You've been working and training home dialysis patients for a long time, right? Was that experience critical to get this right? 

Michelle Carver: I was really excited to be a part of this project, primarily because I'm very passionate about home dialysis. I think it’s the best option for the majority of our patients; so, the ability to influence the content that we're delivering our patients in initial patient training was a big honor for me. And, yes, I've been involved in home dialysis for a very long time. I think I am now past 20 years. One of the big things that I've been able to do is I've trained peritoneal and home hemo patients in the past myself, which gave me some additional insights that helped the creation of the training materials. Because one of the things that I think we had an opportunity to really address is streamlining the training curriculum, and addressing what are the things that our patients need to know to do a safe dialysis treatment at home? There's always ongoing education, but how can we create a plan that is customizable and allows the patients to learn what they need to know to transition home. And then we can build on that education later. 

Brad Puffer: It is getting quite popular. I think we've got more than 8500 patients registered to use the PD education experience. Why do you think it has become so popular? Have you heard feedback directly from our patients and our nurses in the field? 

Michelle Carver: We have. Actually, that's one of the reasons that we decided to do a version 2.0 of the originally released app that we did in the spring, and really that came about because we had so much great feedback from our nurses and patients in the field from the early adoption and utilization of the platform. I think why it became so popular is that prior to the patient training experience, we did have some gaps in the training materials that we had. We had some materials that were housed in the binder, but there were some modules of education or topics that we didn't necessarily have customized specific to home patients. So, with this application, we were able to create content that was very specific to home modalities and put it all in one place, which has really, I think, saved our clinical care teams a lot of time,our training nurses some time, but it also has enabled the patients to have everything they need for training and when they transition home, all in one place. 

Brad Puffer: And when you say all in one place, just to make sure everybody understands, it's essentially an iPad that they're using at home and can access, and we'll get into this, a lot more features, but that training platform is right there on the tablet we provide, correct? 

Michelle Carver: Correct. It's all of their content for training is contained in an application on the iPad, so everything they need is just with a click of the button. 

Brad Puffer: Well, I mentioned how the training platform can be customized for each patient, and I think you mentioned it as well. I'm wondering if you can go into that a little more in detail. How does that work and why is that important? 

Michelle Carver: Certainly. And I will add, I think that may be another reason why this has become so popular for our nurses and our patients is that, by creating a digital platform, we can customize the patient’s training experience based on their needs. So, when a patient begins home dialysis training, the nurse answers a few questions about the patient, and it tells the application what modules of education the patient needs to see on their specific iPad. So, if I'm a patient that's doing peritoneal dialysis, for example, and I'm going to do CAPD (Continuous Ambulatory Peritoneal Dialysis), then we can set up their iPad so that they only see modules of education that pertain directly to the modality in which they're choosing. We also can customize it a little bit based on the patient’s disease. For example, if a patient is diabetic, we can show them some specific modules of education about diabetes. And why that is so important is because it, first of all, is individualized for each patient, and we're not showing patients a bunch of additional content that might not apply to how they will do their dialysis at home. So, I think it reduces some of the anxiety and confusion for patients. I also think it streamlines the training process because it's customized for the patient and the home training nurse knows exactly the modules of education that need to be covered for that patient. 

Brad Puffer: Yeah, I can just imagine. It's hard enough starting at home dialysis, but if you get a huge binder full of paperwork, it can be very overwhelming, so just to have everything on a digital platform, which people are used to using now, must be such a relief for patients. Well, what are some of the most popular features that help our staff the most when it comes to teaching patients about home dialysis? 

Michelle Carver: Some of the popular features that we found that both patients and nurses are excited about is, number one, it enables us to customize the training plan, but also the nurses can visualize the patient’s progress as they go along. So, it's really designed to be instructor led, but patients can complete some modules with some self-guided training and then the nurse can see okay, where is the patient in the completion of their training? How many modules of education have we reviewed and deemed the patient is confident to perform? So, it's very visually easy to see where the patient is in their transition to doing home dialysis and completing training. The other thing is we have now with the new version, a functionality called text to speech. So, for patients that might not necessarily want to read all the information, we can turn on the text to speech functionality and the iPad can read the information to them, which many patients might find beneficial. They can also switch it up, so if there's a day that maybe they don't feel like reading the content, they can turn on that feature and the iPad will read it to them at the pace they want to hear it.

Brad Puffer: That must make it so much easier for patients. I mentioned earlier that this is on an iPad or tablet, but that iPad or tablet is not just for training, correct? And this is built into our connected health platform, PatientHub. Why is that so important? 

Michelle Carver: We know that patients who utilize connected health feel more supported, and we have more visibility into what's going on with our home dialysis treatment. And by incorporating an iPad very early into their training experience, we teach them that the iPad and technology is part of how they'll do dialysis when they're at home. It just becomes habit for them. 

So, while we're teaching the patients and using the iPad to show them their training materials, at the very same time, we're showing them how to use PatientHub, not only to complete their flowsheet, but also do things like reorder their home dialysis supplies, look up their lab results, they can send messages to their care team. So, it becomes part of just how they do dialysis. And, what we've seen by introducing an iPad early in training is we've actually seen an increase in patients submitting flow sheets and also using that technology to order their supplies, which has been very beneficial to both the patients and the care teams. 

Brad Puffer: And I understand now you've taken everything you've learned from this PD education experience that was launched in 2021 and just launched a new home hemodialysis version. Are there major differences between the two and how exciting was it to see that one now out as well? 

Michelle Carver: Well, that's an important piece to touch on, and it really came from the feedback from our home training nurses that have used the initial PD training experience. As they were asking, hey, when are you going to create something like this for home hemodialysis? So, that really spurred us to develop the content for home hemodialysis because we identified that patients wanted it, nurses wanted it. Essentially, the only thing different is the content. So, purposefully, we designed the two applications and it's actually one app with two separate contents so that it looks and feels very similar. And that was intentional because we want to keep patients home. So, for example, if I have a PD patient that's trained and learned how to do PD and then sometime later chooses to or needs to transition to home hemodialysis, Their training materials will look and feel very, very similar. The only thing that will be different is the content that is contained within it. And the nice thing about making it individualized is that we can then go back and customize the training plan for the patient based on their new modality. So, everything they need for the new modality they will be on will be contained in that iPad so they can resource that information very easily. 

Brad Puffer: It strikes me that this platform, this application for training, is not really just helpful for new patients, but once they're part of the connected health system, it's always on. It's always there, right? Why is that so important for ease of use for people to go back and relearn at any point in their journey? 

Michelle Carver: Well, you made this comment earlier about our previous training curriculums existed on paper and in a binder, and you can imagine that when a patient transitioned home and they needed to find something to reference later, they would have to remember where that information was located in their binder. The nice thing about moving it to a digital platform and on an iPad is that patients can use the search function to type in a keyword. Let's say they want to know something about alarms, and the iPad will bring up everything that contains information about alarms very quickly so that they don't have to sift through a bunch of papers to try to find the reference they were looking for. The other big piece is, it's helpful for patients once they transitioned home to look up information when they need it. There's a lot of things they learn in initial training that they might not use right away, and so being able to have that at their fingertips for their entire home dialysis journey, I think is very helpful. I also think it reduces anxiety and makes the patients feel like they have all the tools they need to be successful. 

Brad Puffer: Well, Michelle, do you think this platform and our other connected health tools will give physicians, then, even more confidence to prescribe home dialysis for their patients? 

Michelle Carver: I know our physicians and our care teams. One of the most important things that they focus on is they want to ensure that our home dialysis patients are safe, and they are delivered very high-quality dialysis at home. And this is just an additional tool, like I said, to be able to give patients materials to reference back to, so that they can follow the steps correctly, they can refer to helpful information. It also provides them instructions of when to call their care team, when to notify their nurse of an issue. I do believe that alleviates some of the anxiety for not only our patients, but also our care teams, because it enables us to give them another mechanism to be successful long term in completing their treatments at home. 

Brad Puffer: Well, you mentioned our company goals to really provide home dialysis as an option to almost all patients. How important are these tools in this new education platform to accelerating that adoption? And how excited are you for the future of home dialysis? 

Michelle Carver: Well, I'm very excited for the future of home dialysis, and I can't wait to see how the company will grow this population of patients in the future. I do think this tool is one of the many tools that we're going to find very helpful in increasing the population of patients that are afforded to do home dialysis. And over time, I see this as a, you know, living, breathing thing. I think we're going to learn a lot from our home training nurses and also our patients on how we can make it better for more patients in the future. So, I'm very excited to see us grow home dialysis and offer it to as many patients as we can in the future. 

Brad Puffer: Well, Michelle, it's been great learning from you more about this program, how we've put it together, how it's helping patients, and like we discussed at the end, hopefully how it will help and empower more physicians to prescribe home dialysis for their patients. So, thanks so much for joining us today. 

Michelle Carver: Thank you. 

Brad Puffer: And to our audience, thank you for joining us as well. Don't forget you can find Field Notes on the Apple Store or Google Play or right here at FMCNA.com, where you can also find our Annual Medical Report and other featured articles. Please remember also that vaccines are our number one tool for fighting COVID-19. If you have any questions about the vaccines, please contact your primary care physician or care delivery team. And, if you're not already vaccinated, please protect yourself and your loved ones by getting vaccinated today. Until next time, I’m Brad Puffer, and you've been listening to Field Notes by Fresenius Medical Care. Take care everyone.