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Rationale for a home dialysis virtual ward: design and implementation.

https://arctichealth.org/en/permalink/ahliterature104973
Source
BMC Nephrol. 2014;15:33
Publication Type
Article
Date
2014
Author
Michael E Schachter
Joanne M Bargman
Michael Copland
Michelle Hladunewich
Karthik K Tennankore
Adeera Levin
Matthew Oliver
Robert P Pauly
Jeffrey Perl
Deborah Zimmerman
Christopher T Chan
Author Affiliation
Department of Medicine, Division of Nephrology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. christopher.chan@uhn.ca.
Source
BMC Nephrol. 2014;15:33
Date
2014
Language
English
Publication Type
Article
Keywords
Canada
Delivery of Health Care - methods - organization & administration
Hemodialysis, Home - methods
Humans
Patient Education as Topic - methods - organization & administration
Renal Insufficiency, Chronic - diagnosis - therapy
Software
Software Design
Telemedicine - methods - organization & administration
User-Computer Interface
Abstract
Home-based renal replacement therapy (RRT) [peritoneal dialysis (PD) and home hemodialysis (HHD)] offers independent quality of life and clinical advantages compared to conventional in-center hemodialysis. However, follow-up may be less complete for home dialysis patients following a change in care settings such as post hospitalization. We aim to implement a Home Dialysis Virtual Ward (HDVW) strategy, which is targeted to minimize gaps of care.
The HDVW Pilot Study will enroll consecutive PD and HHD patients who fulfilled any one of our inclusion criteria: 1. following discharge from hospital, 2. after interventional procedure(s), 3. prescription of anti-microbial agents, or 4. following completion of home dialysis training. Clinician-led telephone interviews are performed weekly for 2 weeks until VW discharge. Case-mix (modified Charlson Comorbidity Index), symptoms (the modified Edmonton Symptom Assessment Scale) and patient satisfaction are assessed serially. The number of VW interventions relating to eight pre-specified domains will be measured. Adverse events such as re-hospitalization and health-services utilization will be ascertained through telephone follow-up after discharge from the VW at 2, 4, 12 weeks. The VW re-hospitalization rate will be compared with a contemporary cohort (matched for age, gender, renal replacement therapy and co-morbidities). Our protocol has been approved by research ethics board (UHN: 12-5397-AE). Written informed consent for participation in the study will be obtained from participants.
This report serves as a blueprint for the design and implementation of a novel health service delivery model for home dialysis patients. The major goal of the HDVW initiative is to provide appropriate and effective supports to medically complex patients in a targeted window of vulnerability.
(NCT01912001).
Notes
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PubMed ID
24528505 View in PubMed
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Use of administrative databases for health-care planning in CKD.

https://arctichealth.org/en/permalink/ahliterature123097
Source
Nephrol Dial Transplant. 2012 Oct;27 Suppl 3:iii12-8
Publication Type
Article
Date
Oct-2012
Author
Aminu Bello
Brenda Hemmelgarn
Braden Manns
Marcello Tonelli
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Source
Nephrol Dial Transplant. 2012 Oct;27 Suppl 3:iii12-8
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Alberta
Databases, Factual
Health planning
Health Policy
Humans
Primary Health Care - organization & administration
Public Health
Renal Insufficiency, Chronic - diagnosis - therapy
Abstract
Good-quality information is required to plan healthcare services for patients with chronic diseases. Such information includes measures of disease burden, current care patterns and gaps in care based on quality-of-care indicators and clinical outcomes. Administrative data have long been used as a source of information for policy decisions related to the management of chronic diseases including cardiovascular disease, diabetes and hypertension. More recently, chronic kidney disease (CKD) has been acknowledged as a significant public health issue. Administrative data, particularly when supplemented by the use of routine laboratory data, have the potential to inform the development of optimal CKD care strategies, generate hypotheses about how to slow disease progression and identify risk factors for adverse outcomes. Available data may allow case identification and assessment of rates and patterns of disease progression, evaluation of risk and complications, including current gaps in care, and an estimation of associated costs. In this article, we use the example of the Alberta Kidney Disease Network to describe how researchers and policy makers can collaborate, using administrative data sources to guide health policy for the care of CKD patients.
PubMed ID
22734112 View in PubMed
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