BACKGROUND: Patients' education about transplant, hemodialysis (HD), peritoneal dialysis (PD), and conservative care often is provided by nephrologists as needed and occurs as time allows. STUDY DESIGN: Quality improvement report. SETTING & PARTICIPANTS: Attendees of a national treatment options program (TOPs) who initiated long-term dialysis therapy (median, 3.4 months) at Fresenius Medical Care, North America facilities throughout 2008 were compared with period-prevalent incident patients receiving usual care. QUALITY IMPROVEMENT PLAN: Standardized predialysis treatment options education. OUTCOMES: Rates of opting for PD modality, arteriovenous HD access at initiation, and early (90-day) mortality risk. MEASUREMENTS: Logistic regression (for choice of PD and HD access type) and Cox models (for early mortality) were constructed, including a 1:1 matched cohort. A post hoc sensitivity analysis also compared a propensity score-matched cohort. RESULTS: 3,165 TOPs attendees (10.5% of 30,217 incident patients admitted between January 1 and December 31, 2008), were younger, more likely to be white, and had slightly larger body surface area. The unadjusted OR for TOPs attendees for selecting PD therapy was 8.45 (95% CI, 7.63-9.37) with a case-mix plus laboratory-adjusted OR of 5.13 (95% CI, 3.58-7.35). For patients who opted for in-center HD therapy, the OR was 2.14 (95% CI, 1.96-2.33) and adjusted OR was 2.06 (95% CI, 1.88-2.26) for starting with a fistula or graft. The unadjusted early mortality HR was 0.51 (95% CI, 0.43-0.60) and case-mix plus laboratory-adjusted adjusted HR was 0.61 (95% CI, 0.50-0.74) for TOPs attendees (all outcomes, P < 0.001). These results were consistent in the 1:1 matched analysis and propensity score-matched analysis. LIMITATIONS: It is possible that physicians who referred to these programs were more likely to prescribe PD therapy or place arteriovenous accesses. Motivated, treatment-adherent patients (who would have better outcomes) may have self-selected to attend education sessions. CONCLUSION: Attending an options class predialysis was associated with more frequent selection of home dialysis, fewer tunneled HD catheters, and lower mortality risk during the first 90 days of dialysis therapy.
BACKGROUND:Patients' education about transplant, hemodialysis (HD), peritoneal dialysis (PD), and conservative care often is provided by nephrologists as needed and occurs as time allows. STUDY DESIGN: Quality improvement report. SETTING & PARTICIPANTS: Attendees of a national treatment options program (TOPs) who initiated long-term dialysis therapy (median, 3.4 months) at Fresenius Medical Care, North America facilities throughout 2008 were compared with period-prevalent incident patients receiving usual care. QUALITY IMPROVEMENT PLAN: Standardized predialysis treatment options education. OUTCOMES: Rates of opting for PD modality, arteriovenous HD access at initiation, and early (90-day) mortality risk. MEASUREMENTS: Logistic regression (for choice of PD and HD access type) and Cox models (for early mortality) were constructed, including a 1:1 matched cohort. A post hoc sensitivity analysis also compared a propensity score-matched cohort. RESULTS: 3,165 TOPs attendees (10.5% of 30,217 incident patients admitted between January 1 and December 31, 2008), were younger, more likely to be white, and had slightly larger body surface area. The unadjusted OR for TOPs attendees for selecting PD therapy was 8.45 (95% CI, 7.63-9.37) with a case-mix plus laboratory-adjusted OR of 5.13 (95% CI, 3.58-7.35). For patients who opted for in-center HD therapy, the OR was 2.14 (95% CI, 1.96-2.33) and adjusted OR was 2.06 (95% CI, 1.88-2.26) for starting with a fistula or graft. The unadjusted early mortality HR was 0.51 (95% CI, 0.43-0.60) and case-mix plus laboratory-adjusted adjusted HR was 0.61 (95% CI, 0.50-0.74) for TOPs attendees (all outcomes, P < 0.001). These results were consistent in the 1:1 matched analysis and propensity score-matched analysis. LIMITATIONS: It is possible that physicians who referred to these programs were more likely to prescribe PD therapy or place arteriovenous accesses. Motivated, treatment-adherent patients (who would have better outcomes) may have self-selected to attend education sessions. CONCLUSION: Attending an options class predialysis was associated with more frequent selection of home dialysis, fewer tunneled HD catheters, and lower mortality risk during the first 90 days of dialysis therapy.
Authors: Kevin E Chan; Frank W Maddux; Nina Tolkoff-Rubin; S Ananth Karumanchi; Ravi Thadhani; Raymond M Hakim Journal: Clin J Am Soc Nephrol Date: 2011-09-29 Impact factor: 8.237
Authors: Bessie A Young; Christopher Chan; Christopher Blagg; Robert Lockridge; Thomas Golper; Fred Finkelstein; Rachel Shaffer; Rajnish Mehrotra Journal: Clin J Am Soc Nephrol Date: 2012-10-04 Impact factor: 8.237
Authors: Meera N Harhay; Dawei Xie; Xiaoming Zhang; Chi-Yuan Hsu; Eric Vittinghoff; Alan S Go; Stephen M Sozio; Jacob Blumenthal; Stephen Seliger; Jing Chen; Rajat Deo; Mirela Dobre; Sanjeev Akkina; Peter P Reese; James P Lash; Kristine Yaffe; Manjula Kurella Tamura Journal: Am J Kidney Dis Date: 2018-05-02 Impact factor: 8.860
Authors: Marc Turenne; Regina Baker; Jeffrey Pearson; Chad Cogan; Purna Mukhopadhyay; Elizabeth Cope Journal: Health Serv Res Date: 2017-05-30 Impact factor: 3.402