Overcoming Nutritional Barriers in Hemodialysis Ptnts

描述：(摘自摘要)美国血液透析患者 经常营养不良的。这增加了透析患者的死亡率。 这是工业化国家中最高的，每年22%。穷 营养状况可能也导致了高昂的医疗费用(A 每位患者平均每年住院两次，以及医疗保险总额 每年110亿美元的支出)和生活质量下降。我们的 先前的工作确定了五个潜在的可修改的营养障碍(较差 食欲、透析量不足、营养知识贫乏、低液体 吸食，以及需要帮助购物和烹饪)和试点测试了一种很有前途的 克服这些障碍的方法。 这项建议的基于社区的随机对照试验扩展了我们先前的 通过针对特定营养障碍提供量身定制的反馈和 教育干预。俄亥俄州东北部的30个透析设施将 随机分为干预组和对照组，营养不良者135人 来自15个干预机构的患者和来自15个对照组的135名患者 设施。基线评估将包括营养状况的衡量标准， 具体的障碍、住院费用和生活质量。每月一次 在12个月的基础上，干预患者及其营养师将获得 关于克服患者特定障碍的量身定做的反馈和教育。他们 然后每月开会，共同制定解决这些问题的护理计划 障碍。对照组患者将继续得到常规护理。主要分析 将比较营养参数、住院相关费用、 和生活质量在干预组和对照组患者中进行调整 在设施内对病人进行筑巢。 拟议的项目将测试一种新的干预措施，针对患者和 他们共同做出与营养相关的决定。克服困难 特定的障碍不仅可能导致营养状况的改善，而且还可能 提高患者存活率，降低医疗成本，提高医疗质量 生活。

DESCRIPTION: (taken from abstract) American hemodialysis patients are frequently malnourished. This contributes to dialysis patient mortality rates that are the highest in the industrialized world at 22% per year. Poor nutritional status probably also contributes to high health care costs (an average of two hospitalizations annually per patient and total Medicare expenditures of $11 billion per year) and diminished quality of life. Our prior work identified five potentially modifiable nutritional barriers (poor appetite, inadequate dialysis dose, poor nutritional knowledge, low fluid intake, and needing help shopping and cooking) and pilot tested a promising approach to overcome these barriers. This proposed community-based randomized controlled trial extends our prior work by targeting specific nutritional barriers with a tailored feedback and education intervention. Thirty dialysis facilities in northeast Ohio will be randomly assigned to intervention and control groups, with 135 malnourished patients enrolled from 15 intervention facilities and 135 from 15 control facilities. Baseline evaluation will include measures of nutritional status, specific barriers, inpatient expenditures, and quality of life. On a monthly basis for 12 months, intervention patients and their dietitians will receive tailored feedback and education on overcoming patient-specific barriers. They will then meet monthly to jointly formulate a care plan addressing these barriers. Control patients will continue to get usual care. Major analyses will compare changes in nutritional parameters, hospitalization-related costs, and quality of life in intervention vs. control patients with adjustment for nesting of patients within facilities. The proposed project will test a novel intervention that targets patients and providers as they together make nutrition-related decisions. Overcoming specific barriers may lead not only to improved nutritional status but also to better patient survival, decreased health care costs, and increased quality of life.