Tuso Phillip
Care Management Institute Physician Lead for Total Health.
Perm J. 2013 Fall;17(4):75-8. doi: 10.7812/TPP/13-006.
In 2012, the Kaiser Permanente Area Medical Directors of Quality decided to sponsor analytic activities to improve shared decision making for patients with chronic kidney disease. The objective was to move shared decision making for renal replacement therapy or maximal conservative management upstream rather than waiting until the patient presented to the emergency room requiring acute dialysis. Nephrologists have multiple opportunities to discuss treatment options with patients throughout the course of their disease. However, despite these opportunities most patients beginning dialysis have not experienced shared decision making with their physicians. The shared-decision-making process may help patients understand the importance of being prepared to start dialysis and the benefits of maximal conservative management.By having these discussions upstream we may be able to improve survival (save lives), slow down renal disease progression (save kidneys), preserve central veins for future vascular access (save veins), and be better stewards of finite resources needed to care for patients with end-stage kidney disease (save resources).
2012年，凯撒医疗机构质量区域医疗主任决定发起分析活动，以改善慢性肾病患者的共同决策。目标是将肾替代治疗或最大程度保守治疗的共同决策前置，而不是等到患者因需要紧急透析而被送往急诊室。肾病学家在患者整个病程中有多次机会与他们讨论治疗方案。然而，尽管有这些机会，大多数开始透析的患者并未与医生经历过共同决策过程。共同决策过程可能有助于患者理解为开始透析做好准备的重要性以及最大程度保守治疗的益处。通过在早期进行这些讨论，我们或许能够提高生存率（挽救生命）、减缓肾病进展（挽救肾脏）、保留中心静脉以备未来血管通路使用（挽救静脉），并更好地管理照顾终末期肾病患者所需的有限资源（节省资源）。
