Department of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
Adv Chronic Kidney Dis. 2013 Jul;20(4):320-5. doi: 10.1053/j.ackd.2013.04.004.
The passage of the Medicare Improvements for Patients and Providers Act (MIPPA) encouraged education for Stage 4 CKD patients by reimbursing qualified providers for formal instruction. This marked the first time Medicare reimbursed for kidney disease education. Although the law lays out specific requirements, it leaves much of the structure and content of the instruction up to the providers. The CKD clinic staffed by advanced practitioners (physician assistants, nurse practitioners, and/or clinical nurse specialists) provides a natural fit for patient education. Educated patients choose home modalities more frequently; more often start dialysis with a permanent vascular access; and generally score higher on tests measuring mood, mobility, and anxiety. However, sufficient research into the effects of CKD patient education is lacking.
《医疗保险改善患者与供应商法案》（MIPPA）的通过鼓励对 4 期 CKD 患者进行教育，为合格的供应商提供正式指导的报销。这标志着医疗保险首次报销肾脏疾病教育费用。尽管该法律规定了具体要求，但在指导结构和内容方面仍留给供应商很大的空间。由高级从业者（医生助理、执业护士和/或临床护理专家）组成的 CKD 诊所非常适合进行患者教育。接受过教育的患者更频繁地选择家庭治疗方式；更有可能通过永久性血管通路开始透析；并且在衡量情绪、活动能力和焦虑的测试中通常得分更高。然而，目前缺乏对 CKD 患者教育效果的充分研究。
