TitleRationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis.
Publication TypeJournal Article
Year of Publication2015
AuthorsPorter, AC, Fitzgibbon, ML, Fischer, MJ, Gallardo, R, Berbaum, ML, Lash, JP, Castillo, S, Schiffer, L, Sharp, LK, Tulley, J, Arruda, JA, Hynes, DM
JournalContemp Clin Trials
Volume42
Pagination1-8
Date Published2015 May
ISSN1559-2030
KeywordsBlood Pressure, Comorbidity, Continental Population Groups, Diet, Female, Health Services, Humans, Kidney Failure, Chronic, Male, Middle Aged, Patient Care Management, Patient Care Team, Patient Satisfaction, Patient-Centered Care, Quality Improvement, Quality of Life, Renal Dialysis, Research Design, United States
Abstract
 

In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL.

DOI10.1016/j.cct.2015.02.006
Alternate JournalContemp Clin Trials
PubMed ID25735489
PubMed Central IDPMC4947379
Grant ListK24 DK092290 / DK / NIDDK NIH HHS / United States