Porter Anna C, Fitzgibbon Marian L, Fischer Michael J, Gallardo Rani, Berbaum Michael L, Lash James P, Castillo Sheila, Schiffer Linda, Sharp Lisa K, Tulley John, Arruda Jose A, Hynes Denise M
Section of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown VA Medical Center, Chicago, IL, USA.
Health Promotion Research, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
Contemp Clin Trials. 2015 May;42:1-8. doi: 10.1016/j.cct.2015.02.006. Epub 2015 Feb 28.
In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL.
在美国，超过40万终末期肾病（ESRD）患者需要进行血液透析（HD）以进行肾脏替代治疗。ESRD患者面临着高发病率、高死亡率、资源高利用率以及生活质量（QOL）差的沉重负担。在当前的护理模式下，ESRD患者在多个地点从多个提供者那里接受分散的护理。以患者为中心的医疗之家（PCMH）是一种团队协作方法，可在整个医疗保健连续过程中提供协调护理。虽然这种模式已在糖尿病等复杂慢性病方面显示出一些早期益处，但尚未应用于HD患者。本研究是一项非随机准实验性干预试验，实施了针对肾病的以患者为中心的医疗之家（PCMH-KD）。PCMH-KD通过增加一名普通内科医生、一名药剂师、一名护士协调员和一名社区卫生工作者来扩展现有的透析护理团队（由一名肾病学家、透析护士、透析技术员、社会工作者和营养师组成），所有这些人员将根据需要共同或分别为患者提供服务。主要目标是组建一个全面的多学科护理团队，以改善HD患者的护理协调、生活质量和医疗保健利用情况。将从两个地点招募约240名患者；一个非营利性大学附属透析中心和一个独立的营利性透析中心。结果包括：（i）患者报告的结果，包括生活质量和满意度；（ii）临床结果，包括血压和饮食；（iii）医疗保健利用情况，包括急诊室就诊和住院情况；以及（iv）工作人员的看法。鉴于接受HD治疗的ESRD患者负担沉重，加强护理协调提供了减轻这种负担并改善生活质量的机会。
