Rationale for a home dialysis virtual ward: design and implementation

Title: Rationale for a home dialysis virtual ward: design and implementation
Authors: Schachter, Michael E
Bargman, Joanne M
Copland, Michael
Hladunewich, Michelle
Tennankore, Karthik K
Levin, Adeera
Oliver, Matthew
Pauly, Robert P
Perl, Jeffrey
Zimmerman, Deborah
Chan, Christopher T
Date: 2014-02-14
Abstract: Abstract Background Home-based renal replacement therapy (RRT) [peritoneal dialysis (PD) and home hemodialysis (HHD)] offers independent quality of life and clinical advantages compared to conventional in-center hemodialysis. However, follow-up may be less complete for home dialysis patients following a change in care settings such as post hospitalization. We aim to implement a Home Dialysis Virtual Ward (HDVW) strategy, which is targeted to minimize gaps of care. Methods/design The HDVW Pilot Study will enroll consecutive PD and HHD patients who fulfilled any one of our inclusion criteria: 1. following discharge from hospital, 2. after interventional procedure(s), 3. prescription of anti-microbial agents, or 4. following completion of home dialysis training. Clinician-led telephone interviews are performed weekly for 2 weeks until VW discharge. Case-mix (modified Charlson Comorbidity Index), symptoms (the modified Edmonton Symptom Assessment Scale) and patient satisfaction are assessed serially. The number of VW interventions relating to eight pre-specified domains will be measured. Adverse events such as re-hospitalization and health-services utilization will be ascertained through telephone follow-up after discharge from the VW at 2, 4, 12 weeks. The VW re-hospitalization rate will be compared with a contemporary cohort (matched for age, gender, renal replacement therapy and co-morbidities). Our protocol has been approved by research ethics board (UHN: 12-5397-AE). Written informed consent for participation in the study will be obtained from participants. Discussion This report serves as a blueprint for the design and implementation of a novel health service delivery model for home dialysis patients. The major goal of the HDVW initiative is to provide appropriate and effective supports to medically complex patients in a targeted window of vulnerability. Trial registration ( NCT01912001 ).
URL: http://dx.doi.org/10.1186/1471-2369-15-33
CollectionLibre accès - Publications // Open Access - Publications