Report Title:

Chronic Kidney Disease; Modified Home Care & Community Health Demonstration Project



Appropriates $      in FY 2007-2008 and FY 2008-2009 for a grant pursuant to chapter 42F, Hawaii Revised Statutes, to the St. Francis Healthcare Foundation to support the modified home care and community health demonstration project to address chronic kidney disease, particularly end stage renal disease for patients living in remote areas of the State.



H.B. NO.














relating to chronic kidney disease.





     SECTION 1.  (a)  The legislature finds that chronic kidney disease, which is divided into five stages, affects all age groups.  Patients at the last stage, or end stage renal disease, require dialysis or kidney transplantation.  The cost of treatment and care for end stage renal disease patients is much higher than for patients at the earlier stages.  Currently, Hawaii has about two thousand end stage renal disease patients, which is a forty-four per cent higher prevalence rate than the rest of the nation with one 1,502 per million compared to 1,040 per million nationwide.  The number of such patients in Hawaii is increasing at a five per cent rate annually while the national rate has declined to one per cent.  It is estimated that ten per cent of the State's population, or one hundred thousand individuals, are afflicted with chronic kidney disease.  The current cost of caring for end stage renal disease in the State has reached $125,000,000 and that cost is projected to reach $144,000,000 by 2011.

     The legislature further finds that the St. Francis Healthcare Foundation, in conjunction with the office of Hawaiian affairs and Papa Ola Lokahi, is developing a major chronic kidney disease health care demonstration project to address health care access issues for end stage renal disease in remote areas of Hawaii and to develop a research program to help care for chronic kidney disease.  The focus of the demonstration project is to promote education, detection, prevention, and medical management and treatment for those with chronic kidney disease through a modified home care and community health program.  Under this model, patients in various stages of chronic renal disease would be able to visit a common site within their own community to receive necessary care.  Locating a treatment and care site within the patients' own community will greatly improve patients' quality of life, especially those with end stage renal disease.  Such patients, especially those who live in remote areas of the State, would not have to endure the physical punishment of enduring long commutes to a dialysis facility.  For example, patients living in Hana on the island of Maui presently need to travel a tortuous two-and-a-half hours to a dialysis clinic.  After four hours of dialysis, they need to endure the two-and-a-half-hour return trip.  In order to live, they must endure this three times a week.  The same situation applies to end stage renal disease patients who live on the north shore of Oahu, in the Kau district of the Big Island, and various other remote areas.

     Hemodialysis, or home dialysis, is not practical because of logistics issues such as allocating at least one hundred square feet of space in a patient's home, the need for reliable electric and water service, and proper disposal of waste.  Furthermore, many end stage renal disease patients live in multi-generational households where space and privacy are at a premium.

     Constructing full-scale dialysis facilities within communities is not cost-effective.  An estimate minimum of sixty patients would be needed for such a facility to break even.  The costs of start-up and maintenance of such a full-scale facility in remote areas would be prohibitive and unrealistic.

     The first model of the demonstration project proposes two initial facilities in Kahuku on Oahu and Hana on Maui.  The model uses a modified home care and community health approach that will allow dialysis patients to place their personal dialysis machines within a common facility.  These facilities will have the necessary infrastructure and logistics to accommodate the machines, and trained personnel will be available to administer and monitor treatment.  At the same facility, a multidisciplinary chronic kidney disease team will deliver various services including:

     (1)  Patient education;

     (2)  Dietary counseling;

     (3)  Psychosocial counseling;

     (4)  Laboratory screening;

     (5)  Preventive vaccinations and primary care physician consultation;

     (6)  Evaluation and treatment of co-morbid conditions such as hypertension, diabetes mellitus, and hyperlipidemia;

     (7)  End stage renal disease counseling;

     (8)  Early referral to nephrologists and vascular surgeons;

     (9)  End stage renal disease social worker psychological evaluation and counseling; and

    (10)  Education to address patient and family financial issues.

     (b)  The first model involves:

     (1)  Construction of a permanent community center to care for chronic disease patients;

     (2)  Providing and underwriting equipment, supplies, caregivers, and dialysis treatment for end stage renal disease patients;

     (3)  Providing and underwriting community health screenings;

     (4)  Establishing a chronic kidney disease treatment program for the community;

     (5)  Establishing an information technology infrastructure and database on chronic kidney disease research; and

     (6)  Establishing and developing a chronic kidney disease research program with the University of Hawaii school of medicine.

     (c)  In the second model of the demonstration project, patients living in remote areas who have available space in their homes for hemodialysis will have the opportunity to have a trained caregiver work with them.  These patients may also use the screenings offered by the National Kidney Foundation and be referred to the nearest chronic kidney disease clinic for treatment and monitoring.

     (d)  The purpose of this Act is to appropriate funds to support the modified home care and community health demonstration project for chronic kidney patients.

     SECTION 2.  There is appropriated out of the general revenues of the State of Hawaii the sum of $        , or so much thereof as may be necessary for fiscal year 2007-2008, and the same sum, or so much thereof as may be necessary for fiscal year 2008-2009, as a grant pursuant to chapter 42F, Hawaii Revised Statutes, to the St. Francis Healthcare Foundation to support the modified home care and community health demonstration project.

     The sums appropriated shall be expended by the department of health for the purposes of this Act.

     SECTION 3.  This Act shall take effect on July 1, 2007.