Scherer Jennifer S, Gore Radhika J, Georgia Annette, Cohen Susan E, Caplin Nina, Zhadanova Olga, Chodosh Joshua, Charytan David, Brody Abraham A
Department of Medicine (J.S.S., A.G., S.E.C., N.C., O.Z., J.C., D.C., A.A.B.), NYU Grossman School of Medicine, New York, New York, USA.
Department of Population Health (R.J.G.), NYU Grossman School of Medicine, New York, New York, USA; Family Health Centers at NYU Langone Health (R.J.G.), New York, New York, USA.
J Pain Symptom Manage. 2025 Apr;69(4):e272-e282. doi: 10.1016/j.jpainsymman.2024.12.025. Epub 2025 Jan 7.
Chronic kidney disease (CKD) disproportionately impacts lower socioeconomic groups and is associated with many symptoms and complex decisions. Integration of Kidney Supportive Care (KSC) with CKD care can address these needs. To our knowledge, this approach has not been described in an underserved population.
We describe our adaptation of an ambulatory integrated KSC and CKD clinic for implementation in a safety net hospital. We report our utilization metrics; characteristics of the population served; and visit activities.
We considered modifications from the perspectives of people with CKD, their providers, and the health system. Modifications were informed by meeting notes with key participants (hospital administrators [n = 5], funders [n = 1], and content experts [n = 2]), as well as literature on palliative care program building, safety net hospitals, and KSC. We extracted utilization data for the first 15 months of the clinic's operations, demographics, clinical characteristics, unmet health related social needs, and symptom burden, measured by the Integrated Palliative Outcome Scale-Renal (total Score, and sub-scores of physical, psychological, and practical impact of CKD) from the electronic health record. Results are reported using descriptive statistics.
Adaptions were proactive and done by clinical and administrative leaders. Meetings identified challenges of the safety net setting including people presenting with advanced disease and having several social needs. Modifications to our base model were made in staffing, data collection, and work flow. Show rate was approximately 68%, with a majority of people identifying as Black or Hispanic, and uninsured or on Medicaid. Symptom burden was lower than previous reports, driven by a better psychological sub-score.
We describe a feasible ambulatory care model of KSC in a safety net setting that can serve as a framework for the development of other noncancer palliative care ambulatory clinics. Future work will optimize our model.
慢性肾脏病（CKD）对社会经济地位较低的群体影响尤为严重，且与多种症状和复杂决策相关。将肾脏支持性护理（KSC）与CKD护理相结合可满足这些需求。据我们所知，这种方法尚未在服务不足的人群中得到描述。
我们描述了一种门诊综合KSC和CKD诊所的改编方案，以便在安全网医院实施。我们报告了我们的使用指标、所服务人群的特征以及就诊活动。
我们从CKD患者、他们的医疗服务提供者以及卫生系统的角度考虑了修改意见。通过与关键参与者（医院管理人员[n = 5]、资助者[n = 1]和内容专家[n = 2]）的会议记录，以及关于姑息治疗项目建设、安全网医院和KSC的文献，为修改提供了依据。我们从电子健康记录中提取了诊所运营前15个月的使用数据、人口统计学、临床特征、未满足的与健康相关的社会需求以及症状负担，通过综合姑息治疗结果量表 - 肾脏（总分以及CKD的身体、心理和实际影响的子分数）进行测量。结果采用描述性统计报告。
改编是积极主动的，由临床和行政领导完成。会议确定了安全网环境中的挑战，包括患有晚期疾病且有多种社会需求的患者。我们对基础模型在人员配备、数据收集和工作流程方面进行了修改。就诊率约为68%，大多数患者为黑人或西班牙裔，且未参保或参加医疗补助计划。症状负担低于先前报告，这得益于更好的心理子分数。
我们描述了一种在安全网环境中可行的KSC门诊护理模式，可作为其他非癌症姑息治疗门诊诊所发展的框架。未来的工作将优化我们的模型。
