Impact of the COVID-19 pandemic on virtual care in home dialysis

Background: While almost every provider and the majority of patients in the United States (US) possess the technology needed to conduct a telemedicine visit, prior to the current pandemic utilization in home dialysis was relatively low The current study examined trends in telehealth utilization before and during the COVID-19 pandemic in US home dialysis patients treated by a large dialysis organization in the US Methods: Telehealth was delivered using a proprietary multiparty, video, secure messaging (HIPAA compliant), scheduling, and educational resource telehealth platform DaVita Care Connect™ (DCC™) application IT systems data were utilized to develop ongoing reports depicting patient, facility, and physician adoption rates across 1750 home dialysis programs Data were segmented by geographic areas (9) and by time of COVID-19 dissemination within locales Results: A meaningful increase in telehealth utilization was observed since the start of the pandemic (prior to March 2020) Among 28,500 home dialysis patients treated, the DCC™ application was installed on 18,300 patient cell phones (65 3%) Overall, 16,000 peritoneal dialysis (PD) patients and 2,200 home hemodialysis (HHD) patients participated in a telehealth visit Fifteen thousand visits were performed in April 2020 There were 18,000 messages sent between the care team and patient and 6000 educational resources viewed by patients at home since the COVID-19 pandemic (mid-March) The numbers of social worker and dietician visits and interdisciplinary team rounds also increased over time There was significant variation DCC™ app download and utilization across geographic regions Conclusions: The COVID-19 pandemic has dramatically increased the use of telehealth management for home dialysis patients in the US Examining the impact of virtual visits on patient outcomes going forward will be critical in designing post-COVID care Balancing the integration of telehealth visits and face-to-face visits to optimize care will necessitate advancing a new care model for patients with end-stage kidney disease