The researchers initiated a structured quality improvement program for ESRD patients within their first two weeks and continuing for up to three months of starting dialysis. "The goal of this research was to implement a patient care strategy that focused on improving clinical outcomes in the first 90 days of haemodialysis, through intensified medical, nursing, and dietary focus and empowerment of patients to influence their own health," explains Dr. Raymond Hakim, Brentwood, Tennessee. The program included one-on-one time with nurses, who provided an educational program focusing on patient self-management.
Because new patients are often malnourished, a key emphasis was nutrition teaching, especially the need for adequate amounts of protein and calories. Dietary restrictions were introduced only as needed for the individual patient. Each patient was assigned to a case manager, who actively identified and addressed any medical problems developing in the first weeks and months on dialysis, along with the multidisciplinary team.
The study tracked survival, hospitalisation rates, and other outcomes for 918 patients. Outcomes were compared with those of 1,020 new dialysis patients at clinics not using the program. After three months, patients who went through the improvement program had better nutrition, as reflected by levels of albumin in the blood; and less anaemia.
Patients also improved their scores on tests of knowledge regarding ESRD and its treatment and on quality of life and mental health scores. In the year after starting dialysis, patients spent fewer days in the hospital: an average of 7.2 days, compared to 10.5 days for normal patients. Researchers noted a one-half reduction in mortality rate: 17 per 100 patient-years, compared to 30 per 100 patient-years in the comparison group.
MEDICA.de; Source: American Society of Nephrology