A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales

Roderick, Paul; Armitage, Alison; Nicholson, T.; Mehta, R. J.; Gerard, Karen; Mullee, Mark; Drey, Nicholas; Lamping, Donna L.; Feest, Terry; Greenwood, Roger; Townsend, Joy

doi:10.1053/j.ajkd.2004.03.031

Cited by 21 publications

(19 citation statements)

References 12 publications

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“…To address some of the challenges of providing chronic hemodialysis remote from available nephrologists, various models of remotely delivered care have been developed (2)(3)(4)7,17). Typically, these remote, or satellite centers are staffed by specially trained nurses and/or general nonspecific physicians.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 61% (20,000) receiving chronic dialysis, almost 79% received institutionalized chronic hemodialysis (1). Because of the concentration of nephrologists in urban centers, many dialysis units are responsible for the care of patients residing in remote locations (2)(3)(4)(5)(6)(7), in contrast to traditional care provided by onsite nephrologists in either hospital or community-based units. One Canadian study noted that approximately 24% of chronic dialysis patients live more than 150 km (93 miles) from the nearest available nephrologist (6).…”

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confidence: 99%

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Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Bernstein¹,

Zacharias²,

Blanchard

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Remotely located patients not living close to a nephrologist present major challenges for providing care. Various models of remotely delivered care have been developed, with a gap in knowledge regarding the outcomes of these heterogeneous models. This report describes a satellite care model for remote full-care hemodialysis units managed homogenously in the province of Manitoba, Canada, without onsite nephrologists. Survival in remotely located full-care units is compared with a large, urban full-care center with onsite nephrologists.Design, setting, participants, & measurements: Data from a Canadian provincial dialysis registry were extracted on 2663 patients between 1990 and 2005. All-cause mortality after initiation of chronic hemodialysis was assessed with Cox proportional hazards regression. Both short-term (1 year) and long-term (2 to 5 years) survival were analyzed.Results: Survival for patients receiving remotely delivered care was shown to be better than for those receiving care in the urban care center with this particular Canadian model of care. Furthermore, there was no difference when assessing short-and long-term survival. This was independent of distance from the urban center.Conclusions: Chronic hemodialysis patients receiving remotely delivered care in a specialized facility attain comparable, if not better survival outcomes than their urban counterparts with direct onsite nephrology care. This model can potentially be adapted to other underserviced areas, including increasingly larger urban centers.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Bernstein¹,

Zacharias²,

Blanchard

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Roderick et al [89] (ESRD) HD in renal satellite units vs HD in main renal units in pts with progressive renal insufficiency 1 Unstated, England/Wales…”

Section: Unstated Us -1181mentioning

confidence: 98%

A Review of the Costs and Cost Effectiveness of Interventions in Chronic Kidney Disease

Menzin¹,

Lines²,

Weiner

et al. 2011

PharmacoEconomics

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Given rising healthcare costs and a growing population of patients with chronic kidney disease (CKD), there is an urgent need to identify health interventions that provide good value for money. For this review, the English-language literature was searched for studies of interventions in CKD reporting an original incremental cost-utility (cost per QALY) or cost-effectiveness (cost per life-year) ratio. Published cost studies that did not report cost-effectiveness or cost-utility ratios were also reviewed. League tables were then created for both cost-utility and cost-effectiveness ratios to assess interventions in patients with stage 1-4 CKD, waitlist and transplant patients and those with end-stage renal disease (ESRD). In addition, the percentage of cost-saving or dominant interventions (those that save money and improve health) was compared across these three disease categories. A total of 84 studies were included, contributing 72 cost-utility ratios, 20 cost-effectiveness ratios and 42 other cost measures. Many of the interventions were dominant over the comparator, indicating better health outcomes and lower costs. For the three disease categories, the greatest number of dominant or cost-saving interventions was reported for stage 1-4 CKD patients, followed by waitlist and transplant recipients and those with ESRD (91%, 87% and 55% of studies reporting a dominant or cost-saving intervention, respectively). There is evidence of opportunities to lower costs in the treatment of patients with CKD, while either improving or maintaining the quality of care. In order to realize these cost savings, efforts will be required to promote and effectively implement changes in treatment practices.

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“…Medical supervision of treatment in satellite units is provided by nephrologists based in renal centres. Growth in satellite provision has largely been responsible for the growth in haemodialysis capacity [14]. Satellite units may be either staffed and funded solely through the NHS or operated by commercial providers under contract, either to the local NHS Trust accommodating the parent renal centre, or on an 'Independent Sector Treatment Centre' basis, in which the contract is held by the Secretary of State for Health.…”

Section: Organisation Of Delivery Of Rrt In the Ukmentioning

confidence: 99%

UK Renal Registry 11th Annual Report (December 2008): Chapter 15 The UK Renal Registry, UKRR database, validation and methodology

Ansell

Tomson

2009

Nephron Clin Pract

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The UK Renal Registry receives encrypted data extracts quarterly from each centre providing Renal Replacement Therapy (RRT) in England, Wales and Northern Ireland. Summary data is received from the Scottish Renal Registry to allow national statistics to be compiled. Data from patients receiving haemodialysis in satellite units or at home are reported through the main renal centre. Data from patients with functioning kidney transplants are reported through the centre providing routine clinical follow-up. The data are extracted from a variety of IT systems with varying functionality and no common messaging system, necessitating extensive data validation and cleaning prior to analysis. Growing confidence in the analyses since the inception of the Registry in 1995 has allowed de-anonymised centre-specific analyses of all outcomes, including survival, to be published, although incomplete data returns for primary renal diagnosis and comorbidity at start of RRT limit ability to adjust for case-mix.

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A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales

Cited by 21 publications

References 12 publications

Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

Model for Equitable Care and Outcomes for Remote Full Care Hemodialysis Units

A Review of the Costs and Cost Effectiveness of Interventions in Chronic Kidney Disease

UK Renal Registry 11th Annual Report (December 2008): Chapter 15 The UK Renal Registry, UKRR database, validation and methodology

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