Clinicians' Perspectives on Providing Emergency-Only Hemodialysis to Undocumented Immigrants

Cervantes, Lilia; Richardson, Sara; Raghavan, Rajeev; Hou, Nova; Hasnain‐Wynia, Romana; Wynia, Matthew K.; Kleiner, Catherine; Chonchol, Michel; Tong, Allison

doi:10.7326/m18-0400

Cited by 59 publications

(62 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because of inconsistent, inadequate dialysis, they have endured impaired quality of life, frequent hospitalizations, high rates of access related complications, and increased mortality compared to patients on scheduled dialysis 1-3 . Similar experiences have been reported elsewhere [4][5][6][7][8][9][10] .…”

Section: Local Experience In a Safety-net Hospitalsupporting

confidence: 89%

Dialysis for Undocumented Immigrants: Challenges and Solutions

2020

View full text Add to dashboard Cite

IntroductionUndocumented immigrants with End Stage Kidney Disease (ESKD) have traditionally had very limited options for dialysis care. They are not eligible for Medicare, they are typically not able to afford private insurance, and they are not eligible for assistance through the Affordable Care Act (ACA). A handful of states provide coverage through Medicaid programs. For patients in the state of Texas, this is not an option. Consequently, these patients have no options for scheduled dialysis care and must present to the emergency department for evaluation for emergent dialysis. As a result of federal policy, inpatient dialysis units are not able to provide scheduled dialysis, so these patients can only receive dialysis when a life threatening indication develops. Such practice exposes these patients to adverse health outcomes (including increased mortality) and impaired quality of life, as well as creating a great deal of stress on all levels of the healthcare system and providers, including trainees. As the primary safety net hospital for Dallas County, Parkland Hospital has cared for the vast majority of undocumented immigrants with ESKD in North Texas, and the expected array of problems has been observed. Over the past several years we have engaged in several ongoing team-based, multidisciplinary efforts to improve quality of care for this population. Through allocation of resources, collaboration with other healthcare divisions, development of educational materials, and the creation of partnerships with organizations outside our institution, we have observed improvements in the care of our patients, including increased access to scheduled dialysis, decreased catheter related complications, and decreased mortality. While much work remains, we have been gratified by the improvement in patient care and hope that our story can serve as an example for others faced with similar challenges and spark discussion for needed broader policy changes.

show abstract

Section: Local Experience In a Safety-net Hospitalsupporting

confidence: 89%

Dialysis for Undocumented Immigrants: Challenges and Solutions

2020

View full text Add to dashboard Cite

show abstract

“…Furthermore, in a qualitative study, physicians who worked in safety-net health care systems where undocumented persons receive emergency dialysis reported that determining when to provide emergency dialysis can cause moral distress. 36 Physicians felt that when required to make decisions about who was to receive emergence dialysis, they were forced to weigh social factors, sacrifice quality of care, and even inappropriately report medical status in order for the patient to qualify for emergency dialysis. 36 Thus, in addition to the moral distress caused by the unavailability of organ retransplantation for patients with undocumented status, physicians face additional stress in providing a suitable medical alternative.…”

Section: Physicians' Responsibilitiesmentioning

confidence: 99%

“…36 Physicians felt that when required to make decisions about who was to receive emergence dialysis, they were forced to weigh social factors, sacrifice quality of care, and even inappropriately report medical status in order for the patient to qualify for emergency dialysis. 36 Thus, in addition to the moral distress caused by the unavailability of organ retransplantation for patients with undocumented status, physicians face additional stress in providing a suitable medical alternative. Moreover, retransplantation is associated with a 50% reduction in mortality relative to remaining on dialysis if the patient survives beyond the 1-year postretransplant period.…”

Section: Physicians' Responsibilitiesmentioning

confidence: 99%

Is Organ Retransplantation Among Undocumented Immigrants in the United States Just?

Ackah

Sigireddi

Murthy

2019

AMA Journal of Ethics

View full text Add to dashboard Cite

“…Less important, but still relevant, is the effect on providers who deliver care to these patients. Cervantes et al 24 recently outlined some of the experiences of these providers and the moral distress they incur as part of this substandard care, and the contribution to physician burnout from their frustration with the system.…”

Section: Q6b What Logistic Burden Do the Systems Of Emergency Dialysmentioning

confidence: 99%

Dialysis in Undocumented Patients: Death on the Doorstep of the Emergency Department

Schneberk

Cooper

2018

Annals of Emergency Medicine

View full text Add to dashboard Cite

Clinicians' Perspectives on Providing Emergency-Only Hemodialysis to Undocumented Immigrants

Abstract: Robert Wood Johnson Foundation and Doris Duke Charitable Foundation.

Cited by 59 publications

References 24 publications

Dialysis for Undocumented Immigrants: Challenges and Solutions

Dialysis for Undocumented Immigrants: Challenges and Solutions

Is Organ Retransplantation Among Undocumented Immigrants in the United States Just?

Dialysis in Undocumented Patients: Death on the Doorstep of the Emergency Department

Contact Info

Product

Resources

About