Early intervention improves mortality and hospitalization rates in incident hemodialysis patients: RightStart program.
OBJECTIVE
Annualized mortality rates of chronic hemodialysis (CHD) patients in their first 90 d of treatment range from 24 to 50%. Limited studies also show high hospitalization rates. It was hypothesized that a structured quality improvement program (RightStart), focused on medical needs and patient education and support, would improve outcomes for incident CHD patients.


METHODS
A total of 918 CHD incident patients were prospectively enrolled in a multicenter RightStart Program, and compared with a time-concurrent group of 1020 control patients from non-RightStart clinics. RightStart patients received 3 mo of intervention in management of anemia, dosage of dialysis, nutrition, and dialysis access and a comprehensive educational program. Outcomes were tracked for up to 12 mo.


RESULTS
At 3 mo, RightStart patients had higher albumin and hematocrit values. Dose of dialysis and permanent access placement were not statistically significantly different from control subjects. Compared with baseline, Mental Composite Score for RightStart patients improved significantly. Mean hospitalization days per patient year were reduced with RightStart versus control subjects. Mortality rates at 3, 6, and 12 mo were 20, 18, and 17 for RightStart patients versus 39, 33, and 30 deaths per 100 patient-years for control subjects, respectively.


CONCLUSIONS
A structured program of prompt medical and educational strategies in incident CHD patients results in improved morbidity and mortality that last up to 1 yr.
Wingard
Rebecca L
RL
Fresenius Medical Care-North America, Inc., Nashville, Tennessee, USA.
Pupim
Lara B
LB
Krishnan
Mahesh
M
Shintani
Ayumi
A
Ikizler
T Alp
TA
Hakim
Raymond M
RM
D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality* / Q000523:psychology