Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Semin Dial. 2020 Nov;33(6):440-448. doi: 10.1111/sdi.12929. Epub 2020 Oct 31.
Caring for patients with end-stage kidney disease (ESKD) in the United States is challenging, due in part to the complex epidemiology of the disease's progression as well as the ways in which care is delivered. As CKD progresses toward ESKD, the number of comorbidities increases and care involves multiple healthcare providers from multiple subspecialties. This occurs in the context of a fragmented US healthcare delivery system that is traditionally siloed by provider specialty, organization, as well as systems of payment and administration. This article describes the role of care fragmentation in the delivery of optimal ESKD care and identifies research gaps in the evidence across the continuum of care. We then consider the impact of care fragmentation on ESKD care from the patient and health system perspectives and explore opportunities for system-level interventions aimed at improving care for patients with ESKD.
美国照顾终末期肾病（ESKD）患者具有挑战性，部分原因在于该疾病进展的复杂流行病学以及提供护理的方式。随着慢性肾脏病向终末期肾脏病的进展，合并症的数量增加，护理涉及来自多个亚专业的多个医疗保健提供者。这是在美国医疗保健提供系统碎片化的背景下发生的，该系统传统上按提供者专业、组织以及支付和管理系统进行隔离。本文描述了护理碎片化在提供最佳 ESKD 护理方面的作用，并确定了整个护理连续体中证据方面的研究空白。然后，我们从患者和卫生系统的角度考虑护理碎片化对 ESKD 护理的影响，并探讨旨在改善 ESKD 患者护理的系统层面干预措施的机会。
