Augmented Nurse Care Management in CKD Stages 4 to 5: A Randomized Trial
| Autor: | Vipul Sakhiya, Sofia Agoritsas, Leah Balsam, Candice Halinski, Hitesh H. Shah, Steven Fishbane, Alessandro Bellucci |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_treatment 030232 urology & nephrology Rate ratio Severity of Illness Index Peritoneal dialysis law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Nursing law Medicine Humans 030212 general & internal medicine Renal Insufficiency Chronic Nursing Process Kidney transplantation Aged business.industry Middle Aged medicine.disease Transplantation Nephrology Private practice Kidney Failure Chronic Female Hemodialysis business Kidney disease |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation. 70(4) |
| ISSN: | 1523-6838 |
| Popis: | Background Outcomes for patients with late-stage chronic kidney disease (CKD) in the United States are suboptimal. There is poor education and preparation for end-stage kidney disease, as well as a high rate of hospitalization in this group of patients. Study Design A randomized, parallel-group, 2-arm, controlled trial. Setting & Participants The study was conducted at 3 sites: a clinic of an academic medical center, a public hospital academic clinic, and a community-based private practice. All participants had late-stage CKD (stages 4-5 CKD). Patients were excluded only if they had significant cognitive impairment. Intervention The care management intervention involved nurse care manager coordination aided by the use of a disease-based informatics system for monitoring patients' clinical status, enhancing CKD education, and facilitating preparation for end-stage kidney disease. The comparison control group received usual late-stage CKD care alone. Outcomes The primary outcome was rate of hospitalization. Measurements Rates of preemptive transplantation, home dialysis, hemodialysis (HD) starts without a hospitalization, and HD therapy initiation rates with catheters or with functioning accesses. Results 130 patients were randomly assigned. The hospitalization rate was significantly lower in the intervention group versus controls: 0.61 versus 0.92 per year, respectively (incidence rate ratio, 0.66; 95% CI, 0.43-0.99; P =0.04). Peritoneal dialysis or preemptive transplantation was the initial end-stage kidney disease treatment in 11 of 30 (37%) participants receiving the intervention versus 3 of 29 (10%) receiving usual care. Among HD starts, treatment was initiated without hospitalization in 11 of 19 (58%) participants in the intervention group versus 6 of 26 (23%) in the control group. At the time of HD therapy initiation, a catheter was present in 7 of 19 (37%) participants in the intervention group versus 18 of 26 (69%) in the control group. A functioning arteriovenous access was in place in 10 of 19 (53%) participants in the intervention group and 7 of 26 (27%) in the control group Limitations Moderate sample size, limited geographic scope. Conclusions The augmented nurse care management intervention resulted in reduced hospitalizations in late-stage CKD and there were suggestions of improved end-stage kidney disease preparation. Given suboptimal outcomes in late-stage CKD, care management interventions could potentially improve patient outcomes. |
| Databáze: | OpenAIRE |
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