title: Clinical and patient-reported outcomes of Chinese patients undergoing haemodialysis in hospital or in the community: A 1-year longitudinal study.
abstract: OBJECTIVE
  Little is known about the effect of haemodialysis (HD) setting on outcomes of patients with end stage renal disease (ESRD). The study aimed at comparing clinical outcomes and patient-reported outcomes (PRO) of patients on community-based (CBHD) and hospital-based haemodialysis (HBHD).
  
  
  METHODS
  A prospective cohort of Chinese ESRD patients receiving HBHD (n = 89) or CBHD (n = 117) in Hong Kong were followed up for 12 months. Subjects were assessed on clinical outcomes of dialysis adequacy (Kt/V) and blood haemoglobin and PRO of health-related quality of life (SF-12v2), general health condition (Global Rating Scale (GRS)) and confidence to cope with their illness (Patient Enablement Instrument (PEI)). Differences between groups were analyzed by independent t-tests for the SF-12v2, GRS and PEI scores. χ(2) tests were used to analyze the difference in proportion of patients reaching the targets of Kt/V and blood haemoglobin and with GRS > 0 and PEI > 0. Multiple linear and logistic regressions were performed to assess the adjusted difference-in-difference estimation.
  
  
  RESULTS
  The mean PEI and GRS scores of CBHD patients at 12 months were significantly higher than those of HBHD patients. CBHD patients had significantly greater improvement in self-efficacy and were more likely to be enabled after 12 months than the HBHD patients.
  
  
  CONCLUSIONS
  The study showed similar clinical outcomes and PRO between CBHD and HBHD but CBHD was more effective than HBHD in promoting patient enablement over a 12-month period. The results suggest added value for patients receiving CBHD and support the transfer of HD care from the hospital to the community.
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Julie Y
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Eric Yf
authors.initials: EY
authors.lastname: Wan
authors.affiliation: School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Edmond Ph
authors.initials: EP
authors.lastname: Choi
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Carlos Kh
authors.initials: CKh
authors.lastname: Wong
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Anca Kc
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Karina Hy
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Philip Kt
authors.initials: PK
authors.lastname: Li
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Cindy Lk
authors.initials: CL
authors.lastname: Lam
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003153:Community Health Services; D005260:Female; D006304:Health Status; D006454:Hemoglobins / Q000378:metabolism; D006723:Hong Kong; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000071066:Patient Reported Outcome Measures; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis; D012307:Risk Factors; D020377:Self Efficacy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: community centre; end stage renal disease; haemodialysis; hospital; quality of care