PROJECT SUMMARY In the United States, >47,000 dialysis patient care technicians (PCTs) are responsible for the technical management of in-center hemodialysis (HD) for nearly 500,000 patients. The authority for dialysis PCTs to perform other clinical tasks varies by state, but it may be common practice to delegate inappropriate tasks to dialysis PCTs. In fact, there were <5000 licensed practical/vocational nurses nationwide in dialysis clinics in 2018, suggesting that dialysis PCTs are likely providing much of the medical care that might otherwise be assigned to these nurses. Further, relative to other team members, PCTs spend the most time with patients in the dialysis clinic, presenting a clear opportunity to engage dialysis PCTs in improving the quality of dialysis care overall. Even with mandated interdisciplinary dialysis care teams and ongoing national quality improvement efforts that are tied to reimbursement, delivery of high-quality, patient-centered dialysis care remains elusive in the United States. Our overarching goal is to explore the role of the dialysis PCT in dialysis care, informing future efforts to increase overall quality of care in the dialysis setting by engaging PCTs. In Aim 1, we will use national administrative data describe patterns of dialysis PCT staffing (e.g., number of PCTs, percentage of PCT positions that are open, PCT:patient and PCT:other staff ratios) over time and explore associations of this staffing with patient outcomes (e.g., hospitalization, mortality, transplant and waitlisting, permanent vascular access use) using quantitative methods. In Aim 2, we will explore perceptions of the roles and abilities of the dialysis PCT, priorities for PCT training interventions, and potential barriers to their implementation using qualitative methods. Specifically, we will conduct six focus groups (n=6-8 each) with interdisciplinary dialysis care team members (two with PCTs; two with physicians, nurses, social workers, dietitians, and administrators; two with in-center HD patients) to prioritize training needs and identify issues (e.g., communication, cultural competency, person-centered care delivery, organizational culture) that will need to be addressed for PCTs to become valued comembers of the dialysis care team. This proposed formative study, using both secondary data analysis and qualitative data collection, will increase our understanding of dialysis PCT staffing and its potential association with patient outcomes; the amount of care beyond the technical management of hemodialysis that is being, or could be, provided by dialysis PCTs; and the perceived adequacy of training and knowledge among dialysis PCTs to provide that care. The preliminary data collected here will directly inform future studies that will lay the groundwork to improve the ability of the entire dialysis care team to better engage dialysis PCTs—ultimately leading to integrated, coordinated whole-person, 360- degree care to optimize individual and population health outcomes among the disproportionately low-income and minority and older U.S. patients who receive in-center HD.

PROJECT NARRATIVE Although dialysis patient care technicians (PCTs) are the most common providers in U.S. dialysis clinics and spend the most time with patients, little is known about their role on the dialysis care team. In this formative study, we will use national administrative data to increase our understanding of U.S. dialysis PCT staffing patterns and also conduct focus groups of dialysis providers and patients to further understand the amount of care—beyond the technical management of hemodialysis—that is being, or could be, provided by dialysis PCTs. This study will lay the groundwork to ultimately improve the ability of the entire dialysis care team to better engage dialysis PCTs and provide high-quality dialysis care.