The study utilizes a prospective intervention period and a retrospective control period at the same dialysis units, in order to balance efficacy, power, and accuracy. The intervention will be implemented at the unit level and is intended to impact not only the specific patients enrolled in the study but also other patients receiving care in these units. The design avoids the contamination effect and inadvertent cross-overs that would be present with an individual participant randomization design. Because we expect perceptions and practices to be changed among care providers other designs, e.g. cross-over designs, would also be unusable. Cluster randomization may also not be practical given the variation between units in practice patterns and logistics involved in conducting a study with a sufficient number of dialysis to maintain internal validity. The design may be open to potential selection bias and secular trends. Adjustments for these are discussed in the data analysis section.