Assuntos
Derivação Arteriovenosa Cirúrgica/normas , Sistemas Pré-Pagos de Saúde/normas , Falência Renal Crônica/terapia , Garantia da Qualidade dos Cuidados de Saúde , Diálise Renal/normas , Dispositivos de Acesso Vascular/normas , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , California/epidemiologia , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Humanos , Falência Renal Crônica/mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Diálise Renal/estatística & dados numéricos , Dispositivos de Acesso Vascular/estatística & dados numéricosRESUMO
BACKGROUND: Nephrologists report that patients' choice should play an important role in the selection of renal replacement therapy (RRT) for end-stage renal disease (ESRD). In the United States, kidney transplant rates remain low and <10% of patients utilize home dialysis therapies. This study examined the effect of pre-ESRD processes on the selection of RRT among incident ESRD patients. METHODS: Using surveys, data were collected for all patients admitted to 229 dialysis units in ESRD Network 18 between April 1, 2002 and May 31, 2002. A total of 1365 patients began chronic dialysis and 1193 facility (87%) and 428 patient (31%) surveys were returned. RESULTS: Substantial proportions of patients were unaware of their kidney disease (36%) or were not seeing a nephrologist (36%) until <4 months before first dialysis. The presentation of treatment options was delayed (48% either after or < 1 month before the first dialysis). The majority of ESRD patients were not presented with chronic peritoneal dialysis, home hemodialysis, or renal transplantation as options (66%, 88%, and 74%, respectively). Using multivariate analyses, variables significantly associated with selection of chronic peritoneal dialysis as dialysis modality were the probability of chronic peritoneal dialysis being presented as a treatment option and the time spent on patient education. CONCLUSION: An incomplete presentation of treatment options is an important reason for under-utilization of home dialysis therapies and probably delays access to transplantation. Improvements in and reimbursement for pre-ESRD education could provide an equal and timely access for all medically suitable patients to various RRTs.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Educação de Pacientes como Assunto/estatística & dados numéricos , Terapia de Substituição Renal/psicologia , Idoso , Coleta de Dados , Feminino , Hemodiálise no Domicílio/psicologia , Hemodiálise no Domicílio/estatística & dados numéricos , Humanos , Transplante de Rim/psicologia , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrologia/estatística & dados numéricos , Satisfação do Paciente , Diálise Peritoneal/psicologia , Diálise Peritoneal/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Terapia de Substituição Renal/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
The arteriovenous fistula is the "gold standard" for ESRD vascular access, and, after the initial success of the ESRD Network national vascular access improvement initiative, CMS adopted "Fistula First" as a formal CMS Breakthrough Initiative. A formal coalition has been formed from members of the renal stakeholder community, and five task force groups are currently addressing various issues and aspects of the health care system surrounding successful arteriovenous fistula placement.
Assuntos
Derivação Arteriovenosa Cirúrgica , Centers for Medicare and Medicaid Services, U.S./organização & administração , Relações Interinstitucionais , Nefrologia/normas , Diálise Renal/instrumentação , Gestão da Qualidade Total/organização & administração , Derivação Arteriovenosa Cirúrgica/normas , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Benchmarking , Comportamento Cooperativo , Humanos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
ESRD Network 18 has identified numerous opportunities from improvement in the process of modality selection for incident patients commencing maintenance dialysis therapy. The overall goal for the Network is to ensure that all patients are presented with a choice for treatment in a timely manner. This in turn, would lead to better preparation of patients for RRT and hopefully, have a positive impact on the morbidity and mortality of maintenance dialysis patients.
