Division of Palliative Medicine (J.R.L., K.S., R.L., S.G., J.A.T), Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts; Harvard Medical School (J.R.L., R.L., S.G., J.A.T, E.I.M.), Boston, Massachusetts.
Division of Palliative Medicine (J.R.L., K.S., R.L., S.G., J.A.T), Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.R.L., K.S., R.L., K.K., S.G., J.A.T, S.N.Z., T.W.), Boston, Massachusetts.
J Pain Symptom Manage. 2022 Dec;64(6):e331-e339. doi: 10.1016/j.jpainsymman.2022.08.014. Epub 2022 Sep 2.
Patients with kidney disease have notable unmet palliative care needs and represent an underserved population for specialty palliative care teams.
We designed a specialty-aligned interprofessional palliative care service called KidneyPal that is aimed at improving delivery of palliative care to patients with kidney disease through focus groups and iterative improvement cycles.
We iteratively measured the development of KidneyPal through clinical process metrics: percent of the inpatient nephrology census followed by KidneyPal, patient demographics, consult origin, clinician feedback, and self-reported team interventions.
KidneyPal saw 314 unique patients from January 2019 to January 2021. The majority of consultations came from nephrology services though the source of consultation changed over time. We consulted on an average of 13.5% of the entire inpatient nephrology patient hospital census with highest involvement with patients on the inpatient nephrology hemodialysis service (mean of 29.9%). KidneyPal was rated highly by surveyed nephrology clinicians and provided high rates of psychosocial support and goals of care interventions.
The creation of KidneyPal led to us to serve a new cohort of patients with specialty palliative care. We grew over time to serve the full range of patients with kidney disease as defined by our nephrology service lines. We succeeded in doing so by embedding in nephrology and building relationships with those caring for people with kidney disease while tailoring our service and interventions over time.
患有肾脏疾病的患者有明显未满足的姑息治疗需求，代表着专业姑息治疗团队服务不足的人群。
我们设计了一种专业的跨专业姑息治疗服务，称为 KidneyPal，旨在通过焦点小组和迭代改进周期来改善肾脏疾病患者的姑息治疗服务。
我们通过临床过程指标来迭代地衡量 KidneyPal 的发展情况：接受 KidneyPal 随访的住院肾病患者的百分比、患者人口统计学特征、咨询来源、临床医生反馈和自我报告的团队干预措施。
KidneyPal 在 2019 年 1 月至 2021 年 1 月期间为 314 位独特的患者提供了服务。大多数咨询来自肾病科服务，但咨询来源随着时间的推移而发生变化。我们平均对住院肾病患者住院人数的 13.5%进行咨询，其中与住院肾病血液透析服务的患者的参与度最高（平均为 29.9%）。接受调查的肾病临床医生对 KidneyPal 的评价很高，并提供了高比例的社会心理支持和护理目标干预措施。
KidneyPal 的创建使我们能够为新的专业姑息治疗患者群体提供服务。随着时间的推移，我们不断发展壮大，为肾病科服务所定义的所有肾脏疾病患者提供服务。我们通过嵌入肾病科并与照顾肾脏疾病患者的人员建立关系，同时随着时间的推移调整我们的服务和干预措施，成功地做到了这一点。
