Multidisciplinary CKD care enhances outcomes at dialysis initiation.

In 2003, the Nephrology Section at Dartmouth-Hitchcock Medical Center embraced a new concept for providing care that included a continuing care manager and a nephrologist working together with the patient to introduce stage-based education and clinical interventions. This study compares the outcomes of patients initiating hemodialysis or peritoneal dialysis who received CKD care using a multidisciplinary care model (n = 89) with those who received traditional nephrology care (n = 82). Overall, the findings in this study support the use of the multidisciplinary clinic as a method for improving care of the patient with CKD initiating dialysis, and reducing hospital admissions and costs. The care coordination provided in the multidisciplinary setting improved the number of fistulas placed (60.7% vs. 21%, p < 0.001), the number of fistulas used for dialysis initiation (40.4% vs. 12.3, p < 0.001), and the management of anemia with higher hemoglobin levels prior to dialysis initiation (10.9 g/dL vs. 10.0 g/dL, p = 0.003). Patients receiving multidisciplinary care were 42% less likely to be admitted to the hospital for dialysis initiation, had significantly fewer days hospitalized (p = 0.001), fewer admissions (p = 0.005), and reduced charges for a 90-day period (p = 0.003) after dialysis initiation.