Greenfield Health Helps Dialysis Patients Get Their Lives Back
Chronic kidney disease patients in the Detroit area are the focus of an innovative plan to enable access to home dialysis in an entirely novel way, with Tablo.
Greenfield Health Systems, a not-for-profit dialysis services subsidiary of Henry Ford Health System in Detroit, MI, is dealing with the growing kidney disease public health crisis that affects more than 1 million adults in the state, according to National Kidney Foundation of Michigan (NKFM). At the health system, which currently provides dialysis services to more than 2,000 patients in acute, chronic and home settings at its 15 clinics and six hospitals, about 60 new patients crash into dialysis each month.
Following the 2019 Advancing American Kidney Health Executive Order and lessons learned during the height of the COVID-19 pandemic, Greenfield leadership made the decision to redesign their dialysis care from the ground up. Their innovative plan focused on empowering CKD patients to take control of their kidney health, and transition them out of the in-center environment and to the self-care and home setting. The overarching strategic goal was to give patients and their families the ability to live their best lives and, in the process, experience better outcomes. However, a major hurdle stood in the way: the health system’s existing dialysis equipment, which had been used for many years, was not conducive to their patient-focused goal.
Vice President Francesco Reale, a forward-thinking leader who oversees the operations of all Greenfield facilities, was introduced to the Tablo Hemodialysis System from Outset Medical several years ago at a renal administrator conference. His first impression was that the machine was a long-awaited technological innovation in the dialysis device space. But it also represented something much bigger. “When COVID hit, we were forced to innovate our patient care and nursing resources on all fronts. Following the Tablo system’s March 2020 FDA clearance for home use, we knew that it could enable our patient-centered vision,” he says.
The device’s first-of-its-kind, connected and intelligent digital ecosystem resonated with Greenfield’s executive team. “We made the investment in Tablo because we saw alignment around what we were trying to do, and it had nothing to do with equipment. It had everything to do with transitioning our dialysis model, and simplifying care for our nursing team and patients. This was something that highly aligned with us from a value standpoint,” he continues. Reale, who joined Henry Ford and Greenfield six years ago, has more than 15 years of healthcare administration experience include serving as CEO of Fairlane Home Health Care, and Operations Director for DaVita.
Tablo Enables Patient-Centered Approach
To the Greenfield executive team, Tablo was the key to unlocking their program redesign plan, from hospital to home. “We saw that its built-in technology was not just about dialysis, but the design—including its unobtrusiveness, compact size, the touchscreen, the advanced software, real-time data and remote monitoring capabilities—enables access to self-care in an entirely novel way. I think that’s what got everybody at Greenfield excited right away, that it wasn’t a device, it is an approach that lives inside a device that is going to marry well with what we were trying to accomplish. That’s one of the biggest wins that we’ve seen,” he continues.
Greenfield brought in Tablo consoles at its acute dialysis units starting in June 2020, and saw an immediate benefit to their nursing staff. “During the height of COVID, we were training nurses who weren’t necessarily dialysis nurses, who became comfortable in a very short space of time to be able to safely deliver or monitor a treatment under the supervision of dialysis nurses, without fearing the technology. These benefits impacted our overall cost of treatment and labor,” says Reale.
Reale says that their nursing teams were able to then focus on what’s most important: the patient and their family. “Overall our nurses really enjoy using Tablo, and we also have the full support of our nephrologists. One of the unique and transformational qualities I see with the system is that our team is now talking about the patient and their health, and rarely talking about the equipment—a failure point that we’re usually always worried about. This is a very important shift that needs to take place as we get more people home.”
A Strategy for Sending Patients Home
Bill Poirier, Regional Administrator overseeing Greenfield’s home dialysis program, has served in various clinical and administrative roles at Henry Ford for more than 32 years. With a background as an acute and in-center dialysis nurse, he describes the critical importance of enabling patient success at home. “Nothing really has changed over my several decades in dialysis. But now, patients being able to take the Tablo device home and doing what they need to do to live their best life — that is the definition of success.
I absolutely know in my heart that the success of this machine is all on the patient,” he says. “When Tablo became available for home use, we knew immediately that this was something that we wanted to offer our patients. It’s a win-win for everyone.”
Beginning in December 2020, Greenfield transitioned a number of home dialysis patients to Tablo, following a brief training period. “The short and easy training, versus several weeks of training with other devices, makes a world of difference to our nurses, patients and their care partners,” Poirier continues.
The health system has a robust, CKD education-focused plan to increase its home population dramatically, starting before patients need renal replacement when possible. Currently, about 15 to 20% of all their CKD patients go home on either hemodialysis or peritoneal dialysis. “Our CKD program, led by a slew of amazing nurses and our supportive physician providers, teaches people from the get-go in the hospital that they don’t have to go in-center if they don’t want to, and that everybody deserves a chance to go home. That’s our motto,” says Poirier. “If patients are on Tablo at the hospital, we talk to them and their families about being able to adapt to and engage with the treatment, and possibly transition home using the same technology.”
Poirier says that the Tablo system’s intuitiveness is a key to its success at home. “Patients are often afraid of these machines, that they experience in the hospital or in-center, as they’re very complex and usually designed for healthcare providers to run,” he says. “The absolute beauty of Tablo is that it’s patient-facing and intuitive. You can’t skip steps, it tells you what to do using animation and simple directions on the touchscreen. It’s amazing. My home patients tell me that they feel the machine was made for them, and they never want to go on another system.”
“For the first time of any dialysis system, Tablo spans the care continuum from acute, to in-center to home.”
“If you were to take a traditional hemo machine and try and put it in a home, it’s not even a possibility,” adds Reale. “Before Tablo, patients would usually opt for treatment at a clinic, rather than trying to manage it themselves at home. For the first time of any dialysis system, Tablo spans the care continuum from acute, to in-center to home. It can be a dialysis machine that patients are familiar with across all these settings. It’s an important barrier removed from sending the patient home, and increasing their quality of life.”
Reale envisions that in the next five or so years, it will be a given that 50% or more of kidney failure patients are treating at home. “It’s something that is not just a nice to have, it’s a requirement. People, for the most part, don’t want to be dialysis patients. They’re simply a person who needs a dialysis treatment. They want to get back to their life,” he says.
About Greenfield Health Systems
Greenfield Health Systems is the division of Henry Ford Health System that provides dialysis care for patients with kidney disease and kidney failure throughout Metro Detroit. Our team of more than 400 dedicated team members provide expert dialysis care at one of our many units and instruct patients on how to perform dialysis at home.
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