title: Reduction of acute hospital admissions and improvement in outpatient attendance by intensified renal palliative care clinic follow-up: the Hong Kong experience.
abstract: BACKGROUND
  End-stage renal failure patients often fail to attend scheduled renal palliative care clinic (RPCC) follow-up because of acute hospital admissions, causing negative impact on patients' well-being and health care burden.
  
  
  METHODS
  The rates of RPCC attendance, emergency department (ED) attendance, and acute hospital admission per patient from January 2013 to June 2013 were analyzed.
  
  
  METHODS
  Patients who had more than one ED visit within three months were invited to intensify their RPCC follow-up schedule for symptom assessment, medical advice, psychosocial-spiritual care, and social worker support in the subsequent three months.
  
  
  RESULTS
  Nineteen patients were included. The rate of ED attendance (2.63 vs. 0.63, P < 0.007) and acute hospital admission (1.59 vs. 0.58, P < 0.009) was reduced significantly after intensified follow-up. Clinic attendance rates improved from 56% to 85%.
  
  
  CONCLUSIONS
  Our pilot results suggested that intensifying RPCC follow-up minimized the utilization of acute medical services and improved outpatient attendance at RPCC.
authors.affiliation: Palliative Medicine Unit, Grantham Hospital, Hong Kong SAR, People's Republic of China. Electronic address: cky842@yahoo.com.hk.
authors.forename: Kwok Ying
authors.initials: KY
authors.lastname: Chan
authors.affiliation: Palliative Medicine Unit, Grantham Hospital, Hong Kong SAR, People's Republic of China.
authors.forename: Hon Wai Benjamin
authors.initials: HW
authors.lastname: Cheng
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, People's Republic of China.
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.affiliation: Renal Unit, Tung Wah Hospital, Hong Kong SAR, People's Republic of China.
authors.forename: Terence
authors.initials: T
authors.lastname: Yip
authors.affiliation: Palliative Medicine Unit, Grantham Hospital, Hong Kong SAR, People's Republic of China.
authors.forename: Cho Wing
authors.initials: CW
authors.lastname: Li
authors.affiliation: Palliative Medicine Unit, Grantham Hospital, Hong Kong SAR, People's Republic of China.
authors.forename: Mau Kwong
authors.initials: MK
authors.lastname: Sham
authors.affiliation: Palliative Medicine Unit, Grantham Hospital, Hong Kong SAR, People's Republic of China.
authors.forename: Yim Chi
authors.initials: YC
authors.lastname: Wong
authors.affiliation: Palliative Medicine Unit, Grantham Hospital, Hong Kong SAR, People's Republic of China.
authors.forename: Wai Kee Vikki
authors.initials: WK
authors.lastname: Lau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006723:Hong Kong; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012944:Social Support; D063189:Symptom Assessment
keywords: Renal palliative care; clinic; emergency department visit; hospitalization; palliative care follow-up; quality improvement