Innovations to Increase Home Hemodialysis Utilization: The Transitional Care Unit

Hussein, Wael F.; Bennett, Paul N.; Schiller, Brigitte

doi:10.1053/j.ackd.2021.02.009

Cited by 11 publications

(24 citation statements)

References 33 publications

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“…Afin de répondre à ce problème, des unités de transition cliniques (UTC) ont vu le jour [57]. Le modèle UTC consiste en des unités indépendantes qui permettent toutes les modalités de traitement par dialyse dans un même lieu.…”

Section: Transition De La Dialyse Péritonéale à L'hémodialyse à Domic...unclassified

“…Le modèle d'UTC offre un programme structuré par un personnel dédié, avec de meilleurs ratios professionnels/patients qu'une unité conventionnelle, avec la capacité de fournir des services éducatifs et de préparer les patients au parcours de dialyse. Ces programmes comprennent les compétences d'autogestion, l'éducation et l'aide à la décision éclairée, l'intégration des techniques de dialyse et les compétences liées à l'accès vasculaire [57]. Ces unités peuvent être appliquées dans un modèle public (de préférence) ou dans un modèle conventionnel, ce qui entraînera des gains pour le parcours du patient et favorisera les traitements à domicile et de meilleures transitions (Figure 1).…”

Section: Transition De La Dialyse Péritonéale à L'hémodialyse à Domic...unclassified

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Managing Transition between dialysis modalities: a call for Integrated care In Dialysis Units

Dias

Rodrigues

2022

Bull Dial Domic

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Summary Patients with chronic kidney disease have three main possible groups of dialysis techniques: in-center hemodialysis, peritoneal dialysis, and home hemodialysis. Home dialysis techniques have been associated with clinical outcomes that are equivalent and sometimes superior to those of in-center hemodialysisTransitions between treatment modalities are crucial moments. Transition periods are known as periods of disruption in the patient’s life associated with major complications, greater vulnerability, greater mortality, and direct implications for quality of life. Currently, it is imperative to offer a personalized treatment adapted to the patient and adjusted over time.An integrated treatment unit with all dialysis treatments and a multidisciplinary team can improve results by establishing a life plan, promoting health education, medical and psychosocial stabilization, and the reinforcement of health self-care. These units will result in gains for the patient’s journey and will encourage home treatments and better transitions.Peritoneal dialysis as the initial treatment modality seems appropriate for many reasons and the limitations of the technique are largely overcome by the advantages (namely autonomy, preservation of veins, and preservation of residual renal function).The transition after peritoneal dialysis can (and should) be carried out with the primacy of home treatments. Assisted dialysis must be considered and countries must organize themselves to provide an assisted dialysis program with paid caregivers.The anticipation of the transition is essential to improve outcomes, although there are no predictive models that have high accuracy; this is particularly important in the transition to hemodialysis (at home or in-center) in order to plan autologous access that allows a smooth transition.

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Section: Transition De La Dialyse Péritonéale à L'hémodialyse à Domic...unclassified

Managing Transition between dialysis modalities: a call for Integrated care In Dialysis Units

Dias

Rodrigues

2022

Bull Dial Domic

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“…15 Although such programs have multiple objectives, including improving vascular access, optimizing clinical outcomes, and easing patient transitions, promotion of home dialysis and kidney transplantation has traditionally been a key focus of TCUs. [15][16][17][18][19] Data examining the clinical outcomes of incident ESKD patients receiving care at TCUs are limited, with most data coming from small cohort studies. 15,20 In two large US cohort studies from 2007 to 2012, structured early-intervention protocols were associated with reduced mortality and improved outcomes among incident dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

“…Variable in their structure and duration, such programs usually offer individualized patient education through a multidisciplinary care team, combined with enhanced case management 15 . Although such programs have multiple objectives, including improving vascular access, optimizing clinical outcomes, and easing patient transitions, promotion of home dialysis and kidney transplantation has traditionally been a key focus of TCUs 15–19 …”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score‐matched analysis

Blankenship

Usvyat

Kraus

et al. 2023

Hemodialysis International

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Introduction Inadequate predialysis care and education impacts the selection of a dialysis modality and is associated with adverse clinical outcomes. Transitional care units (TCUs) aim to meet the unmet educational needs of incident dialysis patients, but their impact beyond increasing home dialysis utilization has been incompletely characterized. Methods This retrospective study included adults initiating in‐center hemodialysis at a TCU, matched to controls (1:4) with no TCU history initiating in‐center hemodialysis. Patients were followed for up to 14 months. TCUs are dedicated spaces where staff provide personalized education and as‐needed adjustments to dialysis prescriptions. For many patients, therapy was initiated with four to five weekly dialysis sessions, with at least some sessions delivered by home dialysis machines. Outcomes included survival, first hospitalization, transplant waiting‐list status, post‐TCU dialysis modality, and vascular access type. Findings The study included 724 patients initiating dialysis across 48 TCUs, with 2892 well‐matched controls. At the end of 14 months, patients initiating dialysis in a TCU were significantly more likely to be referred and/or wait‐listed for a kidney transplant than controls (57% vs. 42%; p < 0.0001). Initiation of dialysis at a TCU was also associated with significantly lower rates of receiving in‐center hemodialysis at 14 months (74% vs. 90%; p < 0.0001) and higher rates of arteriovenous access (70% vs. 63%; p = 0.003). Although not statistically significant, TCU patients were more likely to survive and less likely to be hospitalized during follow‐up than controls. Discussion Although TCUs are sometimes viewed as only a means for enhancing utilization of home dialysis, patients attending TCUs exhibited more favorable outcomes across all endpoints. In addition to being 2.5‐fold more likely to receive home dialysis, TCU patients were 42% more likely to be referred for transplantation. Our results support expanding utilization of TCUs for patients with inadequate predialysis support.

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“…Transitional care teams composed of multidisciplinary members play an important role in the TCM. Meanwhile, transitional care units (TCUs) have been widely used to provide psychosocial support and meaningful modality education for patients in many countries [ 13 ]. This approach is a cost-effective quality improvement intervention because it can make full use of human and material resources [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with instrumental support in transitional care among older people with chronic disease: a cross-sectional study

et al. 2022

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Background Instrumental support, which is defined as practical, tangible, and informational assistance extended to patients, is crucial for older people in transition. However, little is known about instrumental support in transitional care. Thus, the aim of this study was to evaluate the instrumental support of older people in transitional care. Methods This cross-sectional study was conducted using the Questionnaire of Instrumental Support in Transitional Care (QISCT) to collect data from 747 older people in China from September to November 2020. Survey items consisted of a sociodemographic characteristics questionnaire and the QISCT. Multiple regression analyses were conducted to examine the association between independent variables and the QISCT scores. Results The total score of the QISCT was 39.43 (± 9.11), and there was a significant gap between the anticipated support and received support. The satisfaction of instrumental support was low. Multiple regression analyses showed that educational level, the number of intimate relationships, monthly family income, monthly costs of transitional care, diabetes, and chronic obstructive pulmonary disease were associated with instrumental support in transitional care. Conclusions To cope with the burden caused by chronic disease, the government and transitional care teams should establish a demand-oriented transitional care service model and pay more attention to helping older people obtain adequate and satisfactory instrumental support.

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Innovations to Increase Home Hemodialysis Utilization: The Transitional Care Unit

Cited by 11 publications

References 33 publications

Managing Transition between dialysis modalities: a call for Integrated care In Dialysis Units

Managing Transition between dialysis modalities: a call for Integrated care In Dialysis Units

Assessing the impact of transitional care units on dialysis patient outcomes: A multicenter, propensity score‐matched analysis

Factors associated with instrumental support in transitional care among older people with chronic disease: a cross-sectional study

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