SEATTLE – Improving dialysis patient outcomes in nephrology has become a major focus for the Centers for Medicare & Medicaid Services, and chief medical officers and dialysis clinic medical directors can have an impact on those results, according to speakers at a workshop held here yesterday at the National Renal Administrators Association annual conference.
The content of the all-day program centered on an initiative created by chief medical officers from 14 dialysis providers this past March. The CMOs set a list of priorities in clinical care that could lead to improvements in patient outcomes. Those subjects have been part of a series of articles published in NN&I.
Talks during the meeting on Wednesday included identifying problems in dialysis care based on U.S. Renal Data System data (Allan Collins, MD); guidelines on when to start dialysis (Richard Glassock, MD); initiatives on decreasing hospitalization rates (Diane Wish); methods to improve volume management (Richard Glassock, MD); methods on increase peritoneal dialysis among dialysis patients (Brigitte Schiller, MD, FACP, FASN, Doug Johnson, MD); improving CKD education (Leanna Tyshler, MD, Doug Johnson, MD); the success of urgent start peritoneal dialysis (Steven Guest, MD, Leanna Tyshler, MD), and the use of nutritional supplements and sodium management (Raymond Hakim, MD and Brigitte Schiller, MD, FACP, FASN).
The key to expanding home dialysis therapies –– current data shows an increase from 7% to 9% for peritoneal dialysis alone over the past year––has to do with timely modality education. At Satellite’s Wellbound program, for example, educators offer programs in the off hours so those with jobs can access the services. The centers are also designed and built to make patients feel comfortable, using design themes that reflect a home setting.
“Wellbound centers are inviting, and look like home,” Schiller said. Satellite’s data shows that 23% of incident patients start on peritoneal dialysis. Of the near-1,000 patients educated about dialysis modalities by Wellbound; about 50% have chosen home dialysis therapies, she said.
That high percentage reflects what most nurses and physicians would choose for themselves: in an internal survey, only 5-6% of staff said they would choose in-center dialysis if they had kidney disease; the rest chose home dialysis.