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Dixon, Judith C.

Nursing

2008

MS

This longitudinal, retrospective study looked at outcomes of 271 patients who initiated dialysis at either Dartmouth Hitchcock Medical Center Dialysis or Lancaster Dialysis Unit during the three year period from October 1,002 to September 30, 2005. The patients were categorized into one of three groups. The Intervention patients received care through the multidisciplinary CKD clinic (n=89), the Control group (n=82) received traditional nephrology care, and the Emergent group (n=100) were those who were nephrology nalve or who started dialysis within one month of their initial nephrology evaluation. There were no baseline differences in age (M=64.7), gender (Female 42.1 %), type of insurance at dialysis initiation, or tobacco use. The intervention group had significantly more subjects with a coded comorbid diagnosis of hypertension and diabetes. Statistical comparisons were done between all three groups and were repeated with only the Intervention group and the Traditional Care group.
When compared to the traditional group the multidisciplinary intervention group had significantly more fistulas placed (60.7% vs. 21%; p <.001), significantly more fistulas used at the first dialysis treatment (40.4% vs. 12.3; p < .001). More intervention patients were on erythropoietin replacement (68.2% vs. 36%; pz.001), with significantly higher mean hemoglobin at dialysis initiation (10.8gldl vs. 10.0gldl; p= .003). Subjects in the intervention group were 42% less likely than the traditional care group to be admitted to the hospital for dialysis initiation. The intervention group had significantly less days hospitalized (p=.001), fewer admissions (p= .005), and less charges for a 90 day period (p= .003) after initiation than the traditional group.