Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK.
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
J Nephrol. 2021 Aug;34(4):1215-1224. doi: 10.1007/s40620-020-00878-y. Epub 2020 Oct 10.
The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD.
A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan.
A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20-1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63-2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems.
This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.
本质量改进项目的目的是：（1）主动识别患有衰弱和慢性肾脏病（CKD）的人群；（2）引入一种实用的评估方法，使用综合老年评估（CGA）的原则，对患有衰弱和慢性肾脏病（CKD）的人群进行评估，以识别问题；（3）为患有衰弱和 CKD 的人群引入以患者为中心的管理计划。
2018 年 9 月，引入了使用临床虚弱量表（CFS）的虚弱筛查计划。为 CFS≥5 且非透析或透析依赖的 CKD 患者提供老年评估（GA）。成立了肾脏虚弱多学科团队（MDT）会议，以讨论确定的需求并实施以患者为中心的管理计划。
共对 450 名门诊患者进行了 CFS 筛查。150 名患者（33%）被筛查为虚弱。CFS 评分每增加 1 分，与住院风险比 1.35（95%CI 1.20-1.53）和死亡率风险比 2.15（95%CI 1.63-2.85）独立相关。35 名患者接受了 GA，并在 MDT 会议上进行了讨论。患者经历了中位数为 5.0（IQR 3.0）的问题，其中 34 名（97%）患者经历了至少三个问题。
本质量改进项目详细介绍了在肾脏病中心实施虚弱筛查计划和 GA 服务的方法。可以使用 CFS 识别患有衰弱和 CKD 且有不良结局风险的患者。此外，可以使用 GA 识别问题并实施以患者为中心的管理计划，旨在改善这一脆弱患者群体的结局。
