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.
Cites: J Am Soc Nephrol. 2012 Apr;23(4):687-9522362905
Cites: Clin J Am Soc Nephrol. 2009 Apr;4(4):784-919339408
Cites: J Am Soc Nephrol. 2010 Mar;21(3):499-50620133483
Cites: J Ambul Care Manage. 2001 Apr;24(2):30-4611307575
Cites: Ann Intern Med. 2003 Feb 4;138(3):161-712558354
Cites: Am J Kidney Dis. 2003 Jul;42(1):125-3212830464
Cites: Kidney Int. 2003 Sep;64(3):1004-1112911550
Cites: Kidney Int Suppl. 2003 Dec;(88):S3-1214870873