Improving hemodialysis patient outcomes: a step-by-step approach.

Abstract:

:Hemodialysis patient outcomes are often suboptimal, with one-sixth of patients receiving an inadequate dialysis dose, one-fourth using catheters for vascular access, and more than one-half being malnourished. This review describes a four-step approach for improving dialysis patient outcomes. First, select an outcome to improve. This can be a global outcome such as mortality, morbidity, quality of life, or health care costs or an intermediate outcome (such as dialysis dose) that has a demonstrated link with a global outcome. Second, determine barriers to optimal outcomes. Both patient factors (such as noncompliance) and provider factors (such as the process of care) may act as barriers. Third, intervene on specific barriers. Interventions may involve providing medical or surgical treatment, changing patient or provider behavior, or modifying the system of care. Fourth, disseminate the intervention to other settings. "Early adopters" (those who quickly adopt an innovation) and "opinion leaders" (well-respected local physicians) are especially influential in determining the rate of dissemination. By using this approach, physicians can move from helping an individual patient to improving the outcomes of many patients.

journal_name

Semin Dial

journal_title

Seminars in dialysis

authors

Sehgal AR

doi

10.1046/j.1525-139x.2002.00013.x

subject

Has Abstract

pub_date

2002-01-01 00:00:00

pages

35-7

issue

1

eissn

0894-0959

issn

1525-139X

journal_volume

15

pub_type

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