Integrating a Medical Home in an Outpatient Dialysis Setting: Effects on Health-Related Quality of Life
Integrating primary care has been proposed to reduce fragmented care delivery for patients with complex medical needs. Because of their high rates of morbidity, healthcare use, and mortality, patients with end-stage kidney disease (ESKD) may benefit from increased access to a primary care medical home.
To evaluate the effect of integrating a primary care medical home on health-related quality of life (HRQOL) for patients with ESKD receiving chronic hemodialysis.
Before–after intervention trial with repeated measures at two Chicago dialysis centers.
Patients receiving hemodialysis at either of the two centers.
To the standard hemodialysis team (nephrologist, nurse, social worker, dietitian), we added a primary care physician, a pharmacist, a nurse coordinator, and a community health worker. The intervention took place from January 2015 through August 2016.
Health-related quality of life, using the Kidney Disease Quality of Life (KDQOL) measures.
Of 247 eligible patients, 175 (71%) consented and participated; mean age was 54 years; 55% were men and 97% were African American or Hispanic. In regression analysis adjusted for individual visits with the medical home providers and other factors, there were significant improvements in four of five KDQOL domains: at 12 and 18 months, the Mental Component Score improved from baseline (adjusted mean 49.0) by 2.64 (p = 0.01) and 2.96 (p = 0.007) points, respectively. At 6 and 12 months, the Symptoms domain improved from baseline (adjusted mean = 77.0) by 2.61 (p = 0.02) and 2.35 points (p = 0.05) respectively. The Kidney Disease Effects domain improved from baseline (adjusted mean = 72.7), to 6, 12, and 18 months by 4.36 (p = 0.003), 6.95 (p < 0.0001), and 4.14 (p = 0.02) points respectively. The Physical Component Score improved at 6 months only.
Integrating primary care and enhancing care coordination in two dialysis facilities was associated with improvements in HRQOL among patients with ESKD who required chronic hemodialysis.
KEY WORDSmedical home primary care hemodialysis quality of life kidney disease
We appreciate the time and effort of those who helped to develop and implement this study, especially the pre-implementation training team, the clinical study team, the dialysis center staff at both sites, and the research personnel. We are grateful to the patients and their families who volunteered their time to participate in the study.
This work was supported by funding from the Patient-Centered Outcomes Research Institute (PCORI), contract no. IH-12-11-5420. Infrastructure support was provided by Fresenius Medical Care through its companies Frenova Renal Research and Fresenius Kidney Care. Additional support for this project was provided by the Office of the Vice President for Health Affairs at the University of Illinois at Chicago. Data for this study was provided in part by the University of Illinois at Chicago Center for Clinical and Translational Science, funded by National Center for Advancing Translational Sciences, National Institutes of Health (NIH) (UL1TR002003). Dr. Hynes was supported on a US Department of Veterans Affairs Research Career Scientist Award (RCS-98-352). Ms. Chukwudozie was supported by the GUIDE Cancer Research Training Project (NCI: 1P20CA202908). The manuscript content is solely the responsibility of the authors and does not necessarily reflect the views of PCORI or the US Department of Veterans Affairs or the NIH.
Compliance with Ethical Standard
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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