System-Level Strategies to Improve Home Dialysis

被引:1
|
作者
Watnick, Suzanne [1 ,2 ,3 ,10 ]
Blake, Peter G. [4 ,5 ]
Mehrotra, Rajnish [2 ]
Mendu, Mallika [6 ]
Roberts, Glenda [2 ]
Tummalapalli, Sri Lekha [7 ,8 ]
Weiner, Daniel E. [9 ]
Butler, Catherine R. [2 ,3 ]
机构
[1] Northwest Kidney Ctr, Seattle, WA USA
[2] Univ Washington, Dept Med, Seattle, WA USA
[3] US Dept Vet Affairs, VA Puget Sound Hlth Care Syst, Seattle, WA USA
[4] Western Univ, Div Nephrol, London, ON, Canada
[5] Ontario Renal Network, Toronto, ON, Canada
[6] Brigham & Womens Hosp, Dept Med, Boston, MA USA
[7] Weill Cornell Med, Dept Populat Hlth Sci, New York, NY USA
[8] Rogosin Inst, New York, NY USA
[9] Tufts Med Ctr, Dept Med, Boston, MA USA
[10] Northwest Kidney Ctr, 700 Broadway, Seattle, WA 98122 USA
基金
美国国家卫生研究院;
关键词
chronic dialysis; chronic hemodialysis; health policy; peritoneal dialysis; PROSPECTIVE-PAYMENT SYSTEM; PERITONEAL-DIALYSIS; ECONOMIC-EVALUATION; HEMODIALYSIS; MEDICARE; OUTCOMES; NEPHROLOGY; SOCIETY; MODEL;
D O I
10.2215/CJN.0000000000000299
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Advocacy and policy change are powerful levers to improve quality of care and better support patients on home dialysis. While the kidney community increasingly recognizes the value of home dialysis as an option for patients who prioritize independence and flexibility, only a minority of patients dialyze at home in the United States. Complex system-level factors have restricted further growth in home dialysis modalities, including limited infrastructure, insufficient staff for patient education and training, patient-specific barriers, and suboptimal physician expertise. In this article, we outline trends in home dialysis use, review our evolving understanding of what constitutes high-quality care for the home dialysis population (as well as how this can be measured), and discuss policy and advocacy efforts that continue to shape the care of US patients and compare them with experiences in other countries. We conclude by discussing future directions for quality and advocacy efforts.
引用
收藏
页码:1616 / 1625
页数:10
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