Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis.
In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL.
Section of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown VA Medical Center, Chicago, IL, USA. Electronic address: aporte3@uic.edu.
Anna C
AC
Porter
Health Promotion Research, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
Marian L
ML
Fitzgibbon
Section of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown VA Medical Center, Chicago, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA.
Michael J
MJ
Fischer
Health Promotion Research, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Rani
R
Gallardo
Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
Michael L
ML
Berbaum
Section of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown VA Medical Center, Chicago, IL, USA.
James P
JP
Lash
Midwest Latino Health Research Training and Policy Center, University of Illinois at Chicago, Chicago, IL, USA.
Sheila
S
Castillo
Health Promotion Research, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Linda
L
Schiffer
College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
Lisa K
LK
Sharp
Section of General Internal Medicine, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
John
J
Tulley
Section of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences System and Jesse Brown VA Medical Center, Chicago, IL, USA.
Jose A
JA
Arruda
Health Promotion Research, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA; VA Information Resource Center, Edward Hines Jr. VA Hospital, Hines, IL, USA.
Denise M
DM
Hynes
D001794:Blood Pressure; D015897:Comorbidity; D004032:Diet; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D011788:Quality of Life; D044469:Racial Groups; D006435:Renal Dialysis / Q000379:methods*; D012107:Research Design; D014481:United States
Clinical trial; Medical home; Quality of life