title: A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales.
abstract: BACKGROUND
  The prevalence rate of renal replacement therapy in the United Kingdom has increased significantly, particularly by long-term hemodialysis (HD) therapy in renal satellite units (RSUs). These are largely nurse-run units linked to main renal units (MRUs). We compared outcomes, processes of care, and costs in RSUs with those in MRUs.
  
  
  METHODS
  A cross-sectional comparison was performed of HD patients from a representative sample of 12 RSUs in England and Wales and HD patients in the linked MRUs deemed suitable by the senior nurse for RSU care. Data for patient characteristics, clinical process and outcome measures, health-related quality of life (HRQoL), and patient satisfaction were collected. A partial analysis of National Health Service and social care costs was undertaken. Geographic access was assessed by road time and distance traveled to dialysis sessions.
  
  
  RESULTS
  Seven hundred thirty-six of 895 eligible patients (82%) participated. RSU patients were older (mean age, 63 versus 57 years), but had comorbidity similar to that of MRU patients. There were no significant differences in most processes of care or clinical outcomes; achievement of standards for adequacy of dialysis (urea reduction ratio) was significantly greater in RSU patients and hospitalization in the last year was less frequent. Patient HRQoL was similar, but patient satisfaction was greater in RSU patients. RSU patients potentially saved 19 minutes traveling for each dialysis session. Costs for routine dialysis and health/social care were similar.
  
  
  CONCLUSIONS
  RSUs appear to be as effective as main HD units for a wide spectrum of patients, improve geographic access, and are more acceptable to patients. There is evidence that they are as cost-effective as main units.
authors.affiliation: Health Care Research Unit, University of Southampton, Southampton General Hospital, Southampton, UK. pjr@soton.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.forename: Alison
authors.initials: A
authors.lastname: Armitage
authors.forename: Tricia
authors.initials: T
authors.lastname: Nicholson
authors.forename: Raj
authors.initials: R
authors.lastname: Mehta
authors.forename: Karen
authors.initials: K
authors.lastname: Gerard
authors.forename: Mark
authors.initials: M
authors.lastname: Mullee
authors.forename: Nick
authors.initials: N
authors.lastname: Drey
authors.forename: Donna
authors.initials: D
authors.lastname: Lamping
authors.forename: Terry
authors.initials: T
authors.lastname: Feest
authors.forename: Roger
authors.initials: R
authors.lastname: Greenwood
authors.forename: Joy
authors.initials: J
authors.lastname: Townsend
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007223:Infant; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data*; D014852:Wales