Satellite Healthcare, San Jose, CA; Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, MN.
Satellite Healthcare, San Pablo, CA.
Adv Chronic Kidney Dis. 2022 Jan;29(1):52-58. doi: 10.1053/j.ackd.2022.02.010.
The number and percentage of patients dialyzing at home has steadily increased during the past decade, and federal policy initiatives have driven interest to a new high. However, the mere utilization of home dialysis does not ensure better outcomes for patients and care partners. Although public reporting systems for dialysis quality are mature and robust, the incorporation of home dialysis quality in those systems is immature; the advent of the End-Stage Renal Disease Treatment Choices payment model brings this problem into sharp relief. The home dialysis modalities present both common and unique targets for quality measurement. For both modalities, therapy duration (or its inverse, technique failure) is a potential target. For peritoneal dialysis, peritonitis, catheter complications, and residual kidney function are additional targets; for home hemodialysis, vascular access infections, dialysis adequacy, and treatment adherence are targets. Patient-reported experience measures are also important; this domain is a long-standing disparity, as in-facility hemodialysis patients have been routinely surveyed for several years. The statistical aspect of quality measurement in home dialysis requires some adaptation, as the typical home dialysis program is small, thus presenting a threat to reliability; pooling programs may be necessary. Ultimately, promoting high-quality home dialysis will likely increase utilization of home dialysis.
在过去十年中，在家中进行透析的患者数量和比例稳步增加，联邦政策举措也将人们的兴趣推至新高。然而，仅仅使用家庭透析并不能确保患者和护理人员获得更好的结果。尽管透析质量的公共报告系统已经成熟和完善，但这些系统中并未包含家庭透析质量；终末期肾病治疗选择支付模式的出现使这个问题更加突出。家庭透析模式既有共同的也有独特的质量测量目标。对于这两种模式，治疗时间（或其倒数，技术失败）是一个潜在的目标。对于腹膜透析，腹膜炎、导管并发症和残余肾功能是额外的目标；对于家庭血液透析，血管通路感染、透析充分性和治疗依从性是目标。患者报告的体验测量也很重要；这一领域一直存在差距，因为多年来对住院血液透析患者进行了常规调查。家庭透析中的质量测量的统计方面需要一些调整，因为典型的家庭透析计划规模较小，因此对可靠性构成威胁；可能需要合并计划。最终，提高高质量家庭透析的水平可能会增加家庭透析的使用。
