Lu Declan Shiyu, Akhtar Mishal, Dubrofsky Lisa, Auguste Bourne L
Division of Nephrology, University of Toronto, Toronto, Ontario.
Department of Medicine, Womens' College Hospital, Toronto, Ontario.
Kidney Med. 2024 Sep 5;6(11):100898. doi: 10.1016/j.xkme.2024.100898. eCollection 2024 Nov.
RATIONALE & OBJECTIVE: Investigating the effect of a quality improvement intervention aimed at enhancing the choice of home dialysis among patients through improved educational sessions on dialysis modalities.
A new referral protocol initiated on September 15, 2022, sought to direct patients with advanced kidney disease to modality education sessions. This protocol involved an updated referral form and process, requiring nephrologists to refer patients with an estimated glomerular filtration rate below 15 mL/min/1.73 m or specified Kidney Failure Risk Equation scores to modality educators for education. The impact was measured by the uptake of the education and the choice of home dialysis by patients.
SETTING & PARTICIPANTS: The study took place at Sunnybrook Health Sciences Centre in Toronto, Canada, involving 532 patients across 1,723 clinical encounters from October 2019 to June 2023.
The intervention was predicted to lead to an increase in both the number of patients receiving modality education and those choosing home dialysis.
The primary outcome measured was the selection of home dialysis following modality education, with a secondary focus on the proportion of patients educated post intervention.
Statistical process charts were used for monitoring changes in education uptake and home dialysis selection rates following the intervention.
After implementing the standardized referral system, the proportion of patients receiving modality education increased from 27.1%-56.7%. However, the rate of selecting home dialysis remained constant at 50.9%. Overall home dialysis prevalence at our center averaged 19.6%, remaining lower than the provincial average of 24.4% by the end of the study period.
The study was limited to 1 center, without evaluating patient satisfaction or dissecting the complexity of educational content and delivery.
We succeeded in boosting education rates but failed to achieve higher home dialysis choice rates, possibly owing to the complexity involved in modality choices. We plan to further investigate the factors influencing patient choices during modality education to better promote home dialysis selection.
通过改进透析方式的教育课程，调查一项旨在增加患者家庭透析选择的质量改进干预措施的效果。
2022年9月15日启动的一项新的转诊方案，旨在将晚期肾病患者引导至透析方式教育课程。该方案包括一份更新的转诊表格和流程，要求肾病科医生将估计肾小球滤过率低于15 mL/min/1.73 m²或特定肾衰竭风险方程评分的患者转诊给透析方式教育人员进行教育。通过教育的接受情况和患者对家庭透析的选择来衡量其影响。
该研究在加拿大多伦多的桑尼布鲁克健康科学中心进行，涉及2019年10月至2023年6月期间1723次临床诊疗中的532名患者。
预计该干预措施将导致接受透析方式教育的患者数量和选择家庭透析的患者数量增加。
主要测量结果是透析方式教育后家庭透析的选择情况，次要重点是干预后接受教育的患者比例。
使用统计过程图表来监测干预后教育接受情况和家庭透析选择率的变化。
实施标准化转诊系统后，接受透析方式教育的患者比例从27.1%增至56.7%。然而，选择家庭透析的比例保持在50.9%不变。我们中心的总体家庭透析患病率平均为19.6%，到研究期结束时仍低于该省24.4%的平均水平。
该研究仅限于1个中心，未评估患者满意度，也未剖析教育内容和授课的复杂性。
我们成功提高了教育率，但未能实现更高的家庭透析选择率，可能是由于透析方式选择涉及的复杂性。我们计划进一步调查透析方式教育期间影响患者选择的因素，以更好地促进家庭透析的选择。
