Knowing What We Do and Doing What We Should: Quality Assurance in Hemodialysis

Alquist, Maria; Bosch, Juan P.; Barth, Cláudia; Combe, Christian; Daugirdas, John T.; Hegbrant, Jörgen; Martín, Georges; McIntyre, Christopher W.; O’Donoghue, Dónal; Rodriguez, Hector J.; Santoro, Antonio; Tattersall, James; Vantard, Georges; Wyck, David B. Van; Canaud, Bernard

doi:10.1159/000361050

Cited by 11 publications

(10 citation statements)

References 108 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Modern dialysis machines allow for the continuous online collection of some dialysis parametres in real time (18). Online monitoring showed there is a variation of the delivered dialysis dose (kt/V urea) among treatments (19).…”

Section: Discussionmentioning

confidence: 99%

Assessing the adequacy of hemodialysis as renal replacement therapy

Balcangiu‐Stroescu¹,

Timofte²,

Bălan³

et al. 2019

Ro Med J.

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Assessing the adequacy of hemodialysis as renal replacement therapy

Balcangiu‐Stroescu¹,

Timofte²,

Bălan³

et al. 2019

Ro Med J.

View full text Add to dashboard Cite

show abstract

“…Nephrologists today need to select from dialysis therapy options based not only on clinical criteria but on economic considerations as well [ 125 , 126 ]. The choice of the most appropriate therapy for the patient is primarily made on the strength of published evidence (EBM) particularly based on RCTs, systematic reviews and meta-analyses, all of which provide the basis for guidelines recommended by groups of experts.…”

Section: Value-based Renal Carementioning

confidence: 99%

Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability

Apel

Hornig

Maddux

et al. 2021

Clinical Kidney Journal

View full text Add to dashboard Cite

As the prevalence of chronic kidney disease is expected to rise worldwide over the next decades, provision of renal replacement therapy (RRT), will further challenge budgets of all healthcare systems. Most patients today requiring RRT are treated with haemodialysis (HD) therapy and are elderly. This article demonstrates the interdependence of clinical and sustainability criteria that need to be considered to prepare for the future challenges of delivering dialysis to all patients in need. Newer, more sustainable models of high-value care need to be devised, whereby delivery of dialysis is based on value-based healthcare (VBHC) principles, i.e. improving patient outcomes while restricting costs. Essentially, this entails maximizing patient outcomes per amount of money spent or available. To bring such a meaningful change, revised strategies having the involvement of multiple stakeholders (i.e. patients, providers, payers and policymakers) need to be adopted. Although each stakeholder has a vested interest in the value agenda often with conflicting expectations and motivations (or motives) between each other, progress is only achieved if the multiple blocs of the delivery system are advanced as mutually reinforcing entities. Clinical considerations of delivery of dialysis need to be based on the entire patient disease pathway and evidence-based medicine, while the non-clinical sustainability criteria entail, in addition to economics, the societal and ecological implications of HD therapy. We discuss how selection of appropriate modes and features of delivery of HD (e.g. treatment modalities and schedules, selection of consumables, product life cycle assessment) could positively impact decision-making towards value-based renal care. Although the delivery of HD therapy is multifactorial and complex, applying cost-effectiveness analyses for the different HD modalities (conventional in-centre and home HD) can support in guiding payability (balance between clinical value and costs) for health systems. For a resource intensive therapy like HD, concerted and fully integrated care strategies need to be urgently implemented to cope with the global demand and burden of HD therapy.

show abstract

“…The reimbursement system is usually determined by policy decisions (favouring in-hospital or out-of-hospital treatment; financing public or private structures; increasing high-tolerance modalities, etc.) [14,15,41,54,55,56,57,58].…”

Section: Costs and Reimbursements: Not The Same Storymentioning

confidence: 99%

Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices?

Piccoli

Cabiddu

Breuer

et al. 2019

JCM

View full text Add to dashboard Cite

Allowing patients to live for decades without the function of a vital organ is a medical miracle, but one that is not without cost both in terms of morbidity and quality of life and in economic terms. Renal replacement therapy (RRT) consumes between 2% and 5% of the overall health care expenditure in countries where dialysis is available without restrictions. While transplantation is the preferred treatment in patients without contraindications, old age and comorbidity limit its indications, and low organ availability may result in long waiting times. As a consequence, 30–70% of the patients depend on dialysis, which remains the main determinant of the cost of RRT. Costs of dialysis are differently defined, and its reimbursement follows different rules. There are three main ways of establishing dialysis reimbursement. The first involves dividing dialysis into a series of elements and reimbursing each one separately (dialysis itself, medications, drugs, transportation, hospitalisation, etc.). The second, known as the capitation system, consists of merging these elements in a per capita reimbursement, while the third, usually called the bundle system, entails identifying a core of procedures intrinsically linked to treatment (e.g., dialysis sessions, tests, intradialyitc drugs). Each one has advantages and drawbacks, and impacts differently on the organization and delivery of care: payment per session may favour fragmentation and make a global appraisal difficult; a correct capitation system needs a careful correction for comorbidity, and may exacerbate competition between public and private settings, the latter aiming at selecting the least complex cases; a bundle system, in which the main elements linked to the dialysis sessions are considered together, may be a good compromise but risks penalising complex patients, and requires a rapid adaptation to treatment changes. Retarding dialysis is a clinical and economical goal, but the incentives for predialysis care are not established and its development may be unfavourable for the provider. A closer cooperation between policymakers, economists and nephrologists is needed to ensure a high quality of dialysis care.

show abstract

Knowing What We Do and Doing What We Should: Quality Assurance in Hemodialysis

Cited by 11 publications

References 108 publications

Assessing the adequacy of hemodialysis as renal replacement therapy

Assessing the adequacy of hemodialysis as renal replacement therapy

Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability

Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices?

Contact Info

Product

Resources

About