Developments in Hemodialysis in the Veterans Administration

Parkin, R.

doi:10.1093/milmed/135.4.275

Cited by 2 publications

(1 citation statement)

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“…For over half a century, we have been providing chronic dialysis therapy to patients with end‐stage renal disease (ESRD) . In the 1960s, an ESRD patient with access to dialysis would initiate therapy to lessen complications of uremia, such as peripheral neuropathy, clouded sensorium, and intractable vomiting . Today, clearly, the nephrology community would consider such timing inappropriately late.…”

Section: Cost Differentials and Quality Of Life Scores Per Patient Dumentioning

confidence: 99%

Financial and Medico‐Legal Implications of Late‐Start Dialysis: Understanding the Present Policies through a Window of Past Performance

Watnick

2013

Seminars in Dialysis

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In the United States, multiple stakeholders have impacted the timing of dialysis initiation for patients with end-stage renal disease. The optimal policy to start dialysis for this vulnerable population remains unknown. Historically, patients initiated dialysis weeks after the appearance of uremic symptoms. This changed not only due to an evolution in medical providers' practice but also due to changes in the care delivery system, the political imperatives, and the economic driving forces surrounding the care of these patients. One large randomized control trial looked at patient outcomes with strategies of early versus late start. The trial included an economic analysis. Depending on the specific comparison, cost was either lower in the late-start group or was equivalent between groups. This result would tend to favor a late-start strategy, where patients had an additional 6 months of dialysis-free time. However, the generalizability of this analysis has been questioned. Future care models that would include patients before and after dialysis initiation would be ideal to study cost and quality at the time of this transition of care. The recently implemented CMS Quality Incentive Program is one mechanism that could use such findings to implement a high-value strategy for patients starting chronic dialysis therapies.

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Section: Cost Differentials and Quality Of Life Scores Per Patient Dumentioning

confidence: 99%

Financial and Medico‐Legal Implications of Late‐Start Dialysis: Understanding the Present Policies through a Window of Past Performance

Watnick

2013

Seminars in Dialysis

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ESRD Care Within the US Department of Veterans Affairs: A Forward-Looking Program With an Illuminating Past

Watnick

Crowley

2014

American Journal of Kidney Diseases

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Developments in Hemodialysis in the Veterans Administration

Cited by 2 publications

References 0 publications

Financial and Medico‐Legal Implications of Late‐Start Dialysis: Understanding the Present Policies through a Window of Past Performance

Financial and Medico‐Legal Implications of Late‐Start Dialysis: Understanding the Present Policies through a Window of Past Performance

ESRD Care Within the US Department of Veterans Affairs: A Forward-Looking Program With an Illuminating Past

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