title: An analysis of a case manager-driven emergent dialysis program.
abstract: OBJECTIVE
  With the undocumented immigrant population in the United States on the rise, an increase in the number of patients with end-stage renal disease without access to a regular dialysis chair continues. This leaves hospital systems with the difficult decision of how best to care for this population. We sought to evaluate the feasibility, effectiveness, and costs of a case manager-driven emergent dialysis program. We hypothesized that this program would be feasible and would result in similar costs as the previous regularly scheduled dialysis program in place at our institution.
  
  
  METHODS
  The study was conducted at Wishard Memorial Hospital, which is an urban public hospital in Indianapolis, IN.
  
  
  METHODS
  We performed a before (March 11, 2010, to June 11, 2010) and after (June 14, 2010, to September 14, 2010) study to compare the treatment of a 6-patient cohort of dialysis patients without a "dialysis home" before and after the case manager-driven emergent dialysis program, using secondary data.
  
  
  RESULTS
  The case manager-driven emergent dialysis process was feasible and led to a total expense of $101,802 as compared with a total cost of $122,890 when providing regular dialysis to this subset of patients. There were no differences in intensive care unit days, length of stay, and complications between the 2 groups in the short study period.
  
  
  CONCLUSIONS
  The dialysis population without a "dialysis home" is a high-risk population in need of intensive medical care but the approach to these patients continues to be debated. Although this study does not prove or necessarily support a dialysis on "emergent" basis approach over chronic, scheduled dialysis, the study does demonstrate that case management can play a significant role in the care of these patients. Case management oversight and management of our patient population resulted in costs equal to, or better than, those who received chronic dialysis care without a difference in complications over a 6-month study period.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, 1050 Wishard Boulevard, Room R2200, Indianapolis, IN 46220, USA. chsweave@iupui.edu
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Weaver
authors.forename: Isaac J
authors.initials: IJ
authors.lastname: Myers
authors.forename: Gretchen
authors.initials: G
authors.lastname: Huffman
authors.forename: Rancia
authors.initials: R
authors.lastname: Vohito
authors.forename: Dorian
authors.initials: D
authors.lastname: Herceg
mesh_terms: D019090:Case Management / Q000191:economics / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D054242:Emigrants and Immigrants; D005240:Feasibility Studies; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D007902:Length of Stay; D019982:Organizational Case Studies; D006435:Renal Dialysis / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D013223:Statistics as Topic; D014481:United States; D014505:Urban Population