RAND Corporation, Pittsburgh, Pennsylvania.
Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Am Soc Nephrol. 2022 Oct;33(10):1942-1950. doi: 10.1681/ASN.2022010064. Epub 2022 Jul 12.
Compared with the general Medicare population, patients with ESKD have worse quality metrics for end-of-life care, including a higher percentage experiencing hospitalizations and in-hospital deaths and a lower percentage referred to hospice. We developed a Concurrent Hospice and Dialysis Program in which patients may receive palliative dialysis alongside hospice services. The Program aims to improve access to quality end-of-life care and, ultimately, improve the experiences of patients, caregivers, and clinicians.
We sought to describe () the Program and () enrollment and utilization characteristics of Program participants.
We conducted a quantitative description of demographics, patient characteristics, and utilization of Program enrollees.
Of 43 total enrollees, 44% received at least one dialysis treatment, whereas 56% received no dialysis. The median (range) hospice length of stay was 9 (1-76) days for all participants and 13 (4-76) days for those who received at least one dialysis treatment. The average number of dialysis treatments was 3.5 (range 1-9) for hemodialysis and 19.2 (range 3-65) for peritoneal dialysis. Sixty-five percent of enrollees died at home, 23% in inpatient hospice, and 12% in a nursing facility; no patients died in the hospital.
Our 3-year experience with the Program demonstrated that enrollees had a longer median hospice stay than the previously reported 5-day median for patients with ESKD. Most patients received no further dialysis treatments despite the option to continue dialysis. Our experience provides evidence to support future work testing the effectiveness of such clinical programs to improve patient and utilization outcomes.
与普通医疗保险人群相比，终末期肾病 (ESKD) 患者的临终关怀质量指标更差，包括住院和院内死亡的比例更高，以及接受临终关怀的比例更低。我们开发了一项同时提供临终关怀和透析的计划，在此计划中，患者可以在接受临终关怀服务的同时接受姑息性透析。该计划旨在改善获得高质量临终关怀的机会，并最终改善患者、护理人员和临床医生的体验。
我们旨在描述该计划（）以及计划参与者的入组和使用特征（）。
我们对计划入组者的人口统计学、患者特征和使用情况进行了定量描述。
在总共 43 名入组者中，44%接受了至少一次透析治疗，而 56%没有接受透析治疗。所有参与者的平均（范围）临终关怀住院时间为 9（1-76）天，至少接受一次透析治疗的参与者为 13（4-76）天。血液透析的平均透析治疗次数为 3.5（1-9）次，腹膜透析为 19.2（3-65）次。65%的入组者在家中死亡，23%在住院临终关怀中死亡，12%在护理机构中死亡；没有患者在医院死亡。
我们对该计划的 3 年经验表明，入组者的临终关怀中位时间长于先前报告的 ESKD 患者 5 天的中位时间。尽管有继续透析的选择，但大多数患者没有接受进一步的透析治疗。我们的经验为未来测试此类临床计划以改善患者和利用结果的有效性提供了证据。
