by Allee
Mead
Kelly McGee uses a training mannequin to teach a Kidney
Care Options class.
In 2016, nurse Kelly McGee became ill while admitting a
patient for homecare and was subsequently hospitalized.
There she received a new diagnosis of end-stage kidney
disease (ESKD). “I literally thought I was dying after
being given this diagnosis. No one really said, ‘You’re
going to be okay. ESKD isn’t a death sentence,'” she
said.
Having recently received a life-changing diagnosis,
becoming unable to work, and struggling with feelings of
fear and isolation, McGee was angry and stunned when she
overheard a healthcare provider refer to her as a
“trainwreck” before entering the room.
Melissa O’Connor.
McGee started dialysis and later received a kidney
transplant. In 2023, she became the Chronic Kidney
Disease Coordinator at Major Health Partners (MHP)
in Indiana. She has helped develop the Kidney Care
Options (KCO) Program, providing early patient education
and intervention, care coordination, patient advocacy,
and assistance navigating challenges.
Melissa O’Connor, Director of Nephrology and Infectious
Disease, also has a personal connection to kidney
disease. A registered nurse, she watched her father live
with chronic kidney disease and undergo dialysis for
years. He died of kidney disease and heart failure in
2022. “It made me even more passionate about advocating
for these patients and being a strong voice,” she said.
Kidney Care Options
MHP serves rural Shelby County and patients
from surrounding counties in central and southeastern
Indiana. MHP offers transportation assistance to help
patients access care, while virtual appointments are
available in some circumstances.
The KCO program is a nurse-led, interdisciplinary
initiative designed to educate and support patients
throughout their kidney disease journey. By engaging
patients before disease progression becomes advanced, the
program allows them time to learn about treatment
choices, involve family and community supports, and make
informed decisions.
“When patients are given knowledge early, they gain not
only treatment options, but also confidence, dignity, and
ownership of their care,” O’Connor said.
Nephrologists, nurses, care coordinators, dialysis
providers, transplant centers, and community resources
work together to deliver and improve care. The KCO
program also places a strong emphasis on follow-up,
helping patients navigate challenges, answering
questions, and adjusting care plans as patients move
through the different stages of kidney disease. If
patients are referred elsewhere, the care team makes sure
patients get where they need to go and connect with the
right people or program. The care team also discusses
mental health with patients and helps them access
resources.
Changing kidney care
Before this program was implemented, O’Connor said, many
patients first learned they needed dialysis during an
emergency hospitalization. While some urgent dialysis
starts are unavoidable, she believed too many patients
were reaching that point without enough time to
understand their options.
We owe it to them to be proactive and give them
opportunities months before kidney disease progresses.
“These patients should never be making life-changing
decisions during the worst days of their lives,” O’Connor
said. “We owe it to them to be proactive and give them
opportunities months before kidney disease progresses.”
To implement this program, MHP had to change longstanding
clinical workflows, gain provider buy-in on starting
patient education sooner, and help employees shift from a
disease-centered approach to a patient-centered culture.
MHP worked through this challenge by engaging team
members and discussing shared goals for patient care.
MHP US Renal Care Dialysis Center.
Educating earlier
Earlier in her career, McGee frequently saw older
patients, some in their 90s, start dialysis without fully
exploring whether or not it would improve their quality
of life. The KCO program takes a different approach,
emphasizing education and shared decision-making.
Patients learn about available treatment options and are
empowered to choose the path that best aligns with their
goals, values, and quality of life. “We also share with
them, ‘At any point, you can change your treatment
plan,'” she said.
Although McGee shares her own experience with kidney
disease when appropriate, she is careful not to influence
patients’ decisions. “I don’t push them down the same
paths I took,” she said. “Their journey is personal, and
the decision is theirs to make.”
A patient applies pressure to his dialysis access site
after completing an outpatient hemodialysis treatment.
O’Connor said the patient education itself hasn’t changed
in the nephrology department, but the timing has. “We
start the conversations early,” O’Connor said. “We’re no
longer waiting until a crisis forces the conversation.”
Care team members sit down with patients to discuss their
goals and any social determinants of health. She added
that if a patient is not ready to talk, employees wait
and try again later.
“Every conversation buys a patient something healthcare
too often cannot provide. It’s time,” O’Connor said. “We
give them the time: time to process, time to ask
questions, time to involve their family, and time to make
a decision long before crisis occurs.”
Addressing ‘non-compliance’
Rather than labeling patients as “non-compliant,” McGee
and O’Connor encourage everyone to understand the
barriers preventing patients from following their
treatment plan. Missed appointments or medications are
often symptoms of larger challenges, such as lack of or
limited transportation, low income, limited health
literacy, or competing family responsibilities.
McGee and O’Connor said this culture change at MHP was
not a formal training or process. Instead, they led by
example. They also ask their colleagues, “‘Hey, take a
step back. Have you ever thought about it this
way?’…Nearly every patient you develop a relationship
with has struggles in some way, shape, or form,” O’Connor
said.
Food pantry inside Major Health Partners.
To address food insecurity, the MHP nephrology department
started a food pantry. This is now a shared resource,
benefiting not only nephrology patients but helping
others in crisis as supplies allow. In addition, MHP
partnered with Gleaners2Go,
a program sponsored by Gleaners Food Bank of Indiana, to
establish a distribution site in Shelby County.
Participants can order groceries online and pick them up.
Improving patients’ health
Within three months of program implementation, over 83.3%
of patients received KCO education before starting renal
replacement therapy (treatments like dialysis or
transplant). By 2025, 92% of patients received education.
In 2025, five MHP patients received kidney transplants.
Some patients in the program receive kidney transplants
without going through dialysis.
O’Connor said results from the KCO program exceed
national benchmarks for optimal kidney replacement
therapy starts, preemptive kidney transplants, and home
dialysis utilization among prevalent patients.
MHP received a grant to offer dinners with doctors: a
community education program with presentations on chronic
disease. One doctor gave the presentation in Spanish to
reach Spanish-speaking community members.
O’Connor and McGee recently published a manuscript in the
American Nephrology Nurses Association’s Nephrology
Nursing Journal, discussing the importance of
identifying patient barriers rather than labeling
patients as “non-compliant.”
Success stories
In addition to providing proactive kidney care and
community education, the KCO program addresses patients’
other needs. McGee and O’Connor recall a patient who was
living in a van. He had been told by previous healthcare
providers to “just get a job.” But McGee decided it was
more important to address concerns like housing and a
refrigerator for his insulin.
McGee, O’Connor, and their team helped this man apply for
Social Security Disability Insurance, find an apartment,
get a ride to appointments, and receive gas cards and
food. One day, this patient brought in gas cards to help
other patients.
McGee remembers a dialysis patient who was sleeping on
the floor. MHP raised money to buy this patient a bed.
Another patient needed a babysitter to watch her children
during her dialysis appointments. She shared her story
online and a community member paid for the children to
attend summer camp.
Other patients have received help with medications,
furniture, and eliminating bed bugs. MHP Nephrology was
able to raise funds to help with small basic needs by
hosting a golf benefit.
Melissa O’Connor (second from left) and Kelly McGee
(third from left) pose with other participants at their
first annual golf benefit.
“One of the greatest opportunities in healthcare is to
think outside the box and continually ask how we can
better serve our patients,” O’Connor said. “By providing
education, advocacy, and purposeful follow-up, we can
help patients feel supported as they navigate difficult
decisions and uncertain circumstances. No one should walk
the kidney disease journey alone, and no one should have
to.”
