Model for equitable care and outcomes for remote full care hemodialysis units.
OBJECTIVE
Remotely located patients not living close to a nephrologist present major challenges for providing care. Various models of remotely delivered care have been developed, with a gap in knowledge regarding the outcomes of these heterogeneous models. This report describes a satellite care model for remote full-care hemodialysis units managed homogenously in the province of Manitoba, Canada, without onsite nephrologists. Survival in remotely located full-care units is compared with a large, urban full-care center with onsite nephrologists.


METHODS
Data from a Canadian provincial dialysis registry were extracted on 2663 patients between 1990 and 2005. All-cause mortality after initiation of chronic hemodialysis was assessed with Cox proportional hazards regression. Both short-term (1 year) and long-term (2 to 5 years) survival were analyzed.


RESULTS
Survival for patients receiving remotely delivered care was shown to be better than for those receiving care in the urban care center with this particular Canadian model of care. Furthermore, there was no difference when assessing short- and long-term survival. This was independent of distance from the urban center.


CONCLUSIONS
Chronic hemodialysis patients receiving remotely delivered care in a specialized facility attain comparable, if not better survival outcomes than their urban counterparts with direct onsite nephrology care. This model can potentially be adapted to other underserviced areas, including increasingly larger urban centers.
Bernstein
Keevin
K
Winnipeg, Manitoba R3A 1R9, Canada. kbernstein@HSC.mb.ca
Zacharias
James
J
Blanchard
James F
JF
Yu
B Nancy
BN
Shaw
Souradet Y
SY
D000293:Adolescent; D000328:Adult; D000368:Aged; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D016730:Program Development; D016016:Proportional Hazards Models; D012042:Registries; D019114:Remote Consultation / Q000458:organization & administration*; D006435:Renal Dialysis / Q000401:mortality; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D013997:Time Factors; D016896:Treatment Outcome; D019037:Urban Health Services / Q000458:organization & administration*; D055815:Young Adult