Improving Incident ESRD Care Via a Transitional Care Unit

Brendan Bowman, Sijie Zheng, Alex Yang, Brigitte Schiller, Jose Morfin, Melvin Seek, Robert S. Lockridge

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Dialysis care in the United States continues to move toward an emphasis on continuous quality improvement and performance benchmarking. Government- and industry-sponsored programs have evolved to assess and incentivize outcomes for many components of end-stage renal disease care. One aspect that remains largely unaddressed at a systemic level is the high-risk transition period from chronic kidney disease and acute kidney injury to permanent dialysis dependence. Incident dialysis patients experience disproportionately high mortality and hospitalization rates coupled with high costs. This article reviews the clinical case for a special emphasis on this transition period, reviews published literature regarding prior transitional care programs, and proposes a novel iteration of the first 30 days of dialysis care: the transitional care unit (TCU). The goal of a TCU is to improve awareness of all aspects of renal replacement therapy, including modalities, access, transplantation options, and nutritional and psychosocial aspects of the disease. This enables patients to make truly informed decisions regarding their care. The TCU model is open to all patients, including incident patients with end-stage renal disease, those for whom peritoneal dialysis is failing, or those with failing transplants. This model may be especially beneficial to those who are deemed inadequately prepared or "crash start" patients.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Chronic Kidney Failure
Dialysis
Government Programs
Benchmarking
Renal Replacement Therapy
Peritoneal Dialysis
Quality Improvement
Chronic Renal Insufficiency
Acute Kidney Injury
Industry
Hospitalization
Transplantation
Transitional Care
Transplants
Costs and Cost Analysis
Mortality

Keywords

  • CKD-ESRD transition
  • Dialysis modality selection
  • End-stage renal disease (ESRD)
  • Hemodialysis
  • Home dialysis
  • Incident ESRD
  • Patient-centered care
  • Quality improvement
  • Renal replacement therapy (RRT)
  • Transitional care
  • Transitional care unit (TCU)
  • Vascular access

ASJC Scopus subject areas

  • Nephrology

Cite this

Bowman, B., Zheng, S., Yang, A., Schiller, B., Morfin, J., Seek, M., & Lockridge, R. S. (Accepted/In press). Improving Incident ESRD Care Via a Transitional Care Unit. American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2018.01.035

Improving Incident ESRD Care Via a Transitional Care Unit. / Bowman, Brendan; Zheng, Sijie; Yang, Alex; Schiller, Brigitte; Morfin, Jose; Seek, Melvin; Lockridge, Robert S.

In: American Journal of Kidney Diseases, 01.01.2018.

Research output: Contribution to journalArticle

Bowman, Brendan ; Zheng, Sijie ; Yang, Alex ; Schiller, Brigitte ; Morfin, Jose ; Seek, Melvin ; Lockridge, Robert S. / Improving Incident ESRD Care Via a Transitional Care Unit. In: American Journal of Kidney Diseases. 2018.
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