Multidisciplinary predialysis programs: Quantification and limitations of their impact on patient outcomes in two Canadian settings
Multidisciplinary predialysis programs: Quantification and limitations of their impact on patient outcomes in two Canadian settings
复制标题
DOI：
10.1016/s0272-6386(97)90334-6
复制
发表时间：
1997-04-01
影响因子：
13.2
通讯作者：
Mendelssohn, DC
中科院分区：
文献类型：
--
作者：
Levin, A;Lewis, M;Mendelssohn, DC
1993年美国国立卫生研究院的共识声明强调了在透析前人群中早期医疗干预的重要性，鉴于循证实践的需要，我们报道了加拿大两个主要城市的透析前计划的结果，这份报告的目的是确定建立多学科的透析前计划是否对患者有益，并分析实现这些好处的重要因素，提供了两项不同研究的数据：(1)前瞻性，一项非随机队列研究，比较了有或没有接触到持续的多学科透析前团队(圣保罗医院)的患者和(2)对实施透析前计划(多伦多医院)前后的结果进行回顾的患者。尽管这些计划是在加拿大的主要学术中心独立创建的，但这两个计划都旨在减少紧急透析开始，改善透析准备，并提高资源利用率。温哥华的研究表明，紧急透析开始次数明显减少(13%比35%；P<；0.05)，门诊培训增加(76%比43%；P<；0.05)，透析第一个月住院天数减少(6.5天比13.5天；P<；0.05)。1993年，该计划患者节省的成本保守估计为173,000美元(加元)或每个患者超过4,000美元。多伦多的研究显示，在创建透析前通路方面取得了成功(86.3%的患者)，但由于充分记录的血液透析资源限制，在选择性透析开始方面没有实现任何好处。我们的结论是，多学科团队参与的治疗透析前患者的方法可以对量化结果产生积极影响，但成功的基本要素包括(1)及早转诊到肾病中心，(2)有足够的资源用于专职的透析前计划人员和基础设施，以及(3)为终末期肾病(ESRD)患者(透析站)提供可用的资源。在经济紧张的时期，客观数据是必要的，以证明针对ESRD患者的资源密集型主动计划的合理性，未来的研究应该证实并扩大我们的观察结果，以便为接近ESRD的患者提供统一的最佳和成本效益的护理。(C)1997年，由国家肾脏基金会公司提供。
1993 National Institutes of Health Consensus statement stressed the importance of early medical intervention in predialysis populations, Given the need for evidence-based practice, we report the outcomes of predialysis programs in two major Canadian cities, The purpose of this report was to determine whether the institution of a multidisciplinary predialysis program is of benefit to patients, and to analyze those factors that are important in actualizing those benefits, Data from two different studies is presented: (1) a prospective, nonrandomized cohort study comparing patients who were or were not exposed to an ongoing multidisciplinary predialysis team (St Paul's Hospital) and (2) a retrospective review of outcomes before and after the institution of a predialysis program (The Toronto Hospital), Although created independently in major academic centers in Canada, the programs both aimed to reduce urgent dialysis starts, improve preparedness for dialysis, and improve resource utilization. The Vancouver study was able to demonstrate significantly fewer urgent dialysis starts (13% v 35%; P < 0.05), more outpatient training (76% v 43%; P < 0.05), and less hospital days in the first month of dialysis (6.5 days v 13.5 days; P < 0.05), Cost savings of the program patients in 1993 are conservatively estimated to be $173,000 (Canadian dollars) or over $4,000 per patient. The Toronto study demonstrated success in predialysis access creation (86.3% of patients), but could not realize any benefit in terms of elective dialysis initiation due to well-documented hemodialysis resource constraints. We conclude that an approach to predialysis patients involving a multidisciplinary team can have a positive impact on quantitative outcomes, but essential elements for success include (1) early referral to a nephrology center, (2) adequate resources for dedicated predialysis program staff and infrastructure, and (3) available resources for patients with end-stage renal disease (ESRD) (dialysis stations). In times of economic constraints, objective data are necessary to justify resource-intensive proactive programs for patients with ESRD, Future studies should confirm and extend our observations so that optimum and cost-effective care for patients approaching ESRD is uniformly available. (C) 1997 by the National Kidney Foundation, Inc.