{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:40:32Z","timestamp":1786372832910,"version":"build-2736575974"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"abstract":"<jats:p>\n                    Peritoneal dialysis (PD) use among the US Veteran population is lower than that in the non-Veteran kidney failure population. Increasing choice of and access to high quality home dialysis within the Veteran population is a Veterans Health Administration (VHA) strategic priority. To date, no comprehensive assessment of existing VHA PD programs has been conducted. The VHA PD Committee conducted a nationwide stakeholders survey to inform strategies (\n                    <jats:italic toggle=\"yes\">1<\/jats:italic>\n                    ) to improve Veterans ability to select PD (VHA PD Choice subgroup), (\n                    <jats:italic toggle=\"yes\">2<\/jats:italic>\n                    ) to access PD (VHA PD Access subgroup), and (\n                    <jats:italic toggle=\"yes\">3<\/jats:italic>\n                    ) to receive excellent quality PD (VHA PD Quality subgroup). This manuscript reports findings from the PD quality and respondent characteristic survey items, which were designed to assess current infrastructure and clinical practices for VHA PD services. Participants were invited by email and completed an electronic questionnaire. A total of 27 VHA PD programs responded to the survey (100% response proportion) with a median number of 10 patients. Facility-level variation was found in PD infrastructure and clinical practices, which include differences in services to PD patients, training and staffing ratios for PD nurses, and clinical practices for initiation and maintenance of PD. Large PD programs (more than 10 Veterans) offered a broader range of services (\n                    <jats:italic toggle=\"yes\">e.g<\/jats:italic>\n                    ., outpatient and inpatient PD, urgent-start PD) and reported greater alignment with PD clinical practice guidelines than small PD programs (&lt;10 Veterans). Substantial variability exists in PD infrastructure and clinical practices within VHA, especially in comparisons of small versus large PD programs. Program-aligned facility infrastructure, standardized best clinical practices, and quality assessment and improvement initiatives have already begun to increase successful utilization of PD across VHA.\n                  <\/jats:p>","DOI":"10.2215\/cjn.0000001093","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T16:01:53Z","timestamp":1778860913000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Veterans Health Administration Peritoneal Dialysis Program Infrastructure and Clinical Practices"],"prefix":"10.2215","author":[{"given":"Michael J.","family":"Fischer","sequence":"first","affiliation":[{"name":"Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois"},{"name":"Medicine\/Nephrology, University of Illinois at Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8202-7148","authenticated-orcid":false,"given":"Scott","family":"Reule","sequence":"additional","affiliation":[{"name":"Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota"},{"name":"University of Minnesota Medical Center, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4031-1714","authenticated-orcid":false,"given":"Kerri L.","family":"Cavanaugh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Tennessee Valley Health System, Veterans Health Administration, Nashville, Tennessee"},{"name":"Division of Nephrology, Department of Medicine, Vanderbilt Health, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8968-4098","authenticated-orcid":false,"given":"Anuradha","family":"Wadhwa","sequence":"additional","affiliation":[{"name":"Edward Hines Jr. VA Hospital, Hines, Illinois"},{"name":"Loyola University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6513-8406","authenticated-orcid":false,"given":"Chandana","family":"Reddy","sequence":"additional","affiliation":[{"name":"Bay Pines VA Healthcare System, Bay Pines, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chechamma","family":"George","sequence":"additional","affiliation":[{"name":"James J. Peters VA Medical Center, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7334-5400","authenticated-orcid":false,"given":"Paul M.","family":"Palevsky","sequence":"additional","affiliation":[{"name":"VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8143-5759","authenticated-orcid":false,"given":"Susan T.","family":"Crowley","sequence":"additional","affiliation":[{"name":"VA Connecticut Healthcare System, New Haven, Connecticut"},{"name":"Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda F.","family":"Fried","sequence":"additional","affiliation":[{"name":"VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania"},{"name":"Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1471-0324","authenticated-orcid":false,"given":"Ashutosh M.","family":"Shukla","sequence":"additional","affiliation":[{"name":"VA North Florida South Georgia Healthcare System, Gainesville, Florida"},{"name":"University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"issue":"3 suppl 3","key":"B1-20260624","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1053\/j.ajkd.2008.07.051","article-title":"CKD screening and management in the Veterans Health Administration: the impact of system organization and an innovative electronic record","volume":"53","author":"Patel","year":"2009","journal-title":"Am J Kidney 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