Transitional care units: How successful in increasing home dialysis?

Singh, Namita

doi:10.1111/sdi.12910

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…[15][16][17][18][19] Data examining the clinical outcomes of incident ESKD patients receiving care at TCUs are limited, with most data coming from small cohort studies. 15,20 In two large US cohort studies from 2007 to 2012, structured early-intervention protocols were associated with reduced mortality and improved outcomes among incident dialysis patients. 21,22 Wingard and colleagues also demonstrated that a 3-month quality intervention program that provided protocolized care and in-center education by existing TCU program staff was associated with reduced hospitalization risk, reduced anemia, and improved nutritional status, as assessed by albumin levels.…”

Section: Introductionmentioning

confidence: 99%

“…Survey data suggest patients receiving care at these TCUs are likely to select home dialysis upon completion of the program. 20,23 Nonetheless, a substantial number of patients attending a TCU will opt to continue in-center hemodialysis. Because the clinical outcomes of patients continuing in-center hemodialysis are poorly characterized, we conducted the present study to examine the potential effects of initiating dialysis in a TCU, compared with matched individuals who did not initiate dialysis in a TCU.…”

Section: Introductionmentioning

confidence: 99%

“…Data examining the clinical outcomes of incident ESKD patients receiving care at TCUs are limited, with most data coming from small cohort studies 15,20 . In two large US cohort studies from 2007 to 2012, structured early‐intervention protocols were associated with reduced mortality and improved outcomes among incident dialysis patients 21,22 .…”

Section: Introductionmentioning

confidence: 99%

“…Given the available evidence, a large dialysis organization in North America (Fresenius Medical Care [FMC]) has expanded TCU access to patients initiating dialysis. Survey data suggest patients receiving care at these TCUs are likely to select home dialysis upon completion of the program 20,23 . Nonetheless, a substantial number of patients attending a TCU will opt to continue in‐center hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score‐matched analysis

Blankenship

Usvyat

Kraus

et al. 2023

Hemodialysis International

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Introduction Inadequate predialysis care and education impacts the selection of a dialysis modality and is associated with adverse clinical outcomes. Transitional care units (TCUs) aim to meet the unmet educational needs of incident dialysis patients, but their impact beyond increasing home dialysis utilization has been incompletely characterized. Methods This retrospective study included adults initiating in‐center hemodialysis at a TCU, matched to controls (1:4) with no TCU history initiating in‐center hemodialysis. Patients were followed for up to 14 months. TCUs are dedicated spaces where staff provide personalized education and as‐needed adjustments to dialysis prescriptions. For many patients, therapy was initiated with four to five weekly dialysis sessions, with at least some sessions delivered by home dialysis machines. Outcomes included survival, first hospitalization, transplant waiting‐list status, post‐TCU dialysis modality, and vascular access type. Findings The study included 724 patients initiating dialysis across 48 TCUs, with 2892 well‐matched controls. At the end of 14 months, patients initiating dialysis in a TCU were significantly more likely to be referred and/or wait‐listed for a kidney transplant than controls (57% vs. 42%; p < 0.0001). Initiation of dialysis at a TCU was also associated with significantly lower rates of receiving in‐center hemodialysis at 14 months (74% vs. 90%; p < 0.0001) and higher rates of arteriovenous access (70% vs. 63%; p = 0.003). Although not statistically significant, TCU patients were more likely to survive and less likely to be hospitalized during follow‐up than controls. Discussion Although TCUs are sometimes viewed as only a means for enhancing utilization of home dialysis, patients attending TCUs exhibited more favorable outcomes across all endpoints. In addition to being 2.5‐fold more likely to receive home dialysis, TCU patients were 42% more likely to be referred for transplantation. Our results support expanding utilization of TCUs for patients with inadequate predialysis support.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score‐matched analysis

Blankenship

Usvyat

Kraus

et al. 2023

Hemodialysis International

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show abstract

Chronic Kidney Disease Management Programs and Patient Education

Knicely,

Thavarajah

2023

Management of Chronic Kidney Disease

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The experiences of people starting haemodialysis: A qualitative study

Mehta,

Hussein,

Leuther

et al. 2024

Journal of Renal Care

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Background and ObjectiveStarting dialysis is a life‐changing transition for people living with kidney disease. People feel overwhelmed with diet changes, medications and surgical interventions, and often experience high levels of anxiety, depression and hospital admissions. The objective of this study was to explore and describe the experiences and perspectives of people starting dialysis.Study DesignObservational qualitative study using audio‐recorded, individual, semi‐structured interviews.ParticipantsWe conducted 20 semi‐structured interviews with English‐speaking adults who were within 90 days of starting in‐centre haemodialysis at centres of a nonprofit dialysis provider in Northern California.ApproachTrained qualitative researchers conducted interviews that were deidentified and transcribed verbatim before being inductively coded into codes, categories, and themes.ResultsThree overarching themes emerged from the interviews. Being overwhelmed when starting dialysis, realises the emotional unpreparedness of patients starting dialysis and how the centre's environment (waiting and treatment areas) and staff behaviour impact the dialysis start experience. Making sense of it all, covers how the patient's symptoms, behaviour, and dialysis‐related experiences impact the dialysis start. Moving forward, describes how education informed optimal decision‐making, and can provide hope for a longer and better life.LimitationsPredominantly college‐educated participants were recruited from a single dialysis organisation which may limit the transferability of results.ConclusionUnderstanding the life‐changing experiences that patients encounter when starting dialysis assist dialysis clinicians to help patients adjust and develop long‐term coping strategies.

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Transitional care units: How successful in increasing home dialysis?

Cited by 3 publications

References 21 publications

Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score‐matched analysis

Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score‐matched analysis

Chronic Kidney Disease Management Programs and Patient Education

The experiences of people starting haemodialysis: A qualitative study

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