title: Rationale for a home dialysis virtual ward: design and implementation.
abstract: BACKGROUND
  Home-based renal replacement therapy (RRT) [peritoneal dialysis (PD) and home hemodialysis (HHD)] offers independent quality of life and clinical advantages compared to conventional in-center hemodialysis. However, follow-up may be less complete for home dialysis patients following a change in care settings such as post hospitalization. We aim to implement a Home Dialysis Virtual Ward (HDVW) strategy, which is targeted to minimize gaps of care.
  
  
  METHODS
  The HDVW Pilot Study will enroll consecutive PD and HHD patients who fulfilled any one of our inclusion criteria: 1. following discharge from hospital, 2. after interventional procedure(s), 3. prescription of anti-microbial agents, or 4. following completion of home dialysis training. Clinician-led telephone interviews are performed weekly for 2 weeks until VW discharge. Case-mix (modified Charlson Comorbidity Index), symptoms (the modified Edmonton Symptom Assessment Scale) and patient satisfaction are assessed serially. The number of VW interventions relating to eight pre-specified domains will be measured. Adverse events such as re-hospitalization and health-services utilization will be ascertained through telephone follow-up after discharge from the VW at 2, 4, 12 weeks. The VW re-hospitalization rate will be compared with a contemporary cohort (matched for age, gender, renal replacement therapy and co-morbidities). Our protocol has been approved by research ethics board (UHN: 12-5397-AE). Written informed consent for participation in the study will be obtained from participants.
  
  
  CONCLUSIONS
  This report serves as a blueprint for the design and implementation of a novel health service delivery model for home dialysis patients. The major goal of the HDVW initiative is to provide appropriate and effective supports to medically complex patients in a targeted window of vulnerability.
  
  
  BACKGROUND
  (NCT01912001).
authors: Michael E
authors: ME
authors: Schachter
authors: Joanne M
authors: JM
authors: Bargman
authors: Michael
authors: M
authors: Copland
authors: Michelle
authors: M
authors: Hladunewich
authors: Karthik K
authors: KK
authors: Tennankore
authors: Adeera
authors: A
authors: Levin
authors: Matthew
authors: M
authors: Oliver
authors: Robert P
authors: RP
authors: Pauly
authors: Jeffrey
authors: J
authors: Perl
authors: Deborah
authors: D
authors: Zimmerman
authors: Department of Medicine, Division of Nephrology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. christopher.chan@uhn.ca.
authors: Christopher T
authors: CT
authors: Chan
mesh_terms: D002170:Canada; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration*; D006437:Hemodialysis, Home / Q000379:methods*; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods / Q000458:organization & administration*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy*; D012984:Software; D012985:Software Design; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*; D014584:User-Computer Interface