Reducing early mortality in patients on dialysis: lessons from the RightStart program.

RightStart, a specially designed program for patients new to dialysis, incorporates case manager-driven patient education, encouragement, and empowerment in conjunction with facilitation of prompt and appropriate care provided by the interdisciplinary team. Compared with patients who were not in RightStart, participants exhibited a 41% decrease in the risk of death within the first 90 days of dialysis (hazard ratio 0.59, P < 0.001). The results suggest that a program targeted to new patients on dialysis can significantly reduce early mortality and morbidity while increasing job satisfaction for professionals in the case manager role.