In June 2020, Fresenius Kidney Care announced a strategy to expand Transitional Care Units (TCUs) to help people recently diagnosed with kidney failure learn about the treatment options available to them, including home dialysis.
In this Q&A with Joe Turk, President of Home and Critical Care Therapies for Fresenius Medical Care North America, we discuss how TCUs are providing patients a smoother start into dialysis.
Q: What is a transitional care unit (TCU), and why are they so important for dialysis patients?
JT: Transitional Care Units are small, separate treatment areas, usually within a center and comprising four to eight stations, in which new patients can start dialysis. Typically, the patient will be in a TCU for about four weeks to learn about the different modality options and decide what is best for them. Patients can receive treatments with both in-center and home hemodialysis machines, consistent with their dialysis prescription, as well as familiarize themselves with peritoneal equipment and supplies. The real goal is to give that patient a smooth start into dialysis, allowing them to become comfortable and giving them the opportunity and time to learn.
Q: Is having patients choose home dialysis the end goal?
JT: It is one of our important goals, for sure. Home dialysis has real advantages, whether they be clinical or quality of life improvements for the patient. While home is not necessarily going to be for everybody, we know many more patients could go home than do today. When we think about the way a patient’s introduction to dialysis happens today, about half do not even know that they are going to be on dialysis before they start. The other half may not be in the right mindset to make a decision on whether home is an option for them. By giving patients three or four weeks in the beginning to learn their options, they will be empowered to make the decision that is right for them. Even if home dialysis is not for them, the time spent in the TCU can help them be more knowledgeable when it comes to making their dialysis experience as successful as possible.
Q: How many TCUs does Fresenius Kidney Care (FKC) have open, and what have we learned since introducing TCUs in our centers?
JT: Currently, there are about 70 TCUs open, up from 20 at the start of the year, and we expect to have at least 100 in place by the end of the year. We initially worked with a smaller number of TCUs and pilot programs, helping us answer some questions so that we could determine the best playbook for operations. What is the best size? How does the education process work best for patients? How long should someone stay in the TCU? We also realized that by expanding TCUs, patients should be in control and making many of these important choices in their care.
Q: What benefits does a TCU offer to patients?
JT: Most patients do not expect that they will be on dialysis so a smooth transition into dialysis is key. Our Medical Office is confident that in time we will also see real patient benefits, whether it be fewer patients with temporary catheters which can increase risk of infection, or a reduction in the number of hospitalizations because of better education on and control of fluid overload. We are just beginning to research the impact of the TCU experience over time.
As mentioned before, another real benefit is giving more patients the opportunity to learn about home dialysis. By giving patients weeks of dedicated attention and the time to learn about home therapies, we are seeing that between 40 and 50 percent of the patients who start in the TCU will choose to go home- much higher than if a patient starts and goes directly into an in-center unit without going through a TCU.
Q: What benefits do we see for our care teams?
JT: The biggest benefit for employees in the TCU is that they can be focused on supporting new patients. A new patient is different than a patient who has been in the center for a while, where their dialysis prescription is stabilized. Ongoing teaching does not happen in the same way for experienced patients compared to what is needed for a new patient. Providing focused time to help a new patient understand their options is hugely important for the care teams and helps patients become more empowered and involved in their own care.
Q: Have you already seen some success stories??
JT: We have had several patients, and their families, come to us and thank us for this experience.
One example comes from a patient in our East Mobile, Alabama, TCU who said that the staff, “simplified the technical and scary without being in any way condescending.” He explained that the education and care enabled him to move from fear of the unknown to helping him live a full life while undergoing dialysis at home. We are seeing so many of these positive patient stories.
Patients are facing the unknown, and it helps that they can decide their dialysis modality without feeling pressured. Once they learn more about dialysis, and they have a good introduction, it allows them to make an honest choice.
Q: How does this initiative fit into the company’s goals to significantly grow home dialysis and offer the benefits of home dialysis to more patients?
There are several ways to grow home dialysis. When transplant is not possible for patients, home dialysis can be the next best option, of course, always keeping in mind an individual patient’s needs. One powerful way to offer the benefits of home dialysis is by making sure that more patients have the greatest opportunity to choose home first. Right now, about one in six patients choose to go home on dialysis in their first 90 days of dialysis. We believe that TCUs can dramatically increase that and help the company meet its goals to offer home dialysis to more patients.
About Joe Turk
Joe Turk is the President of Fresenius Medical Care North America’s Home and Critical Care Therapies. Previously, he served as president of NxStage since November 2013. Before that, he served as president of North American Operations from December 2010 to November 2013; senior vice president, Commercial Operations, from January 2005 to December 2010; and vice president, Sales and Marketing, from May 2000 to January 2005.