Advertisement

Geriatric Nephrology and Urology

, Volume 8, Issue 2, pp 69–76 | Cite as

Comparative cost-analysis of two different chronic care facilities for end-stage renal disease patients

  • S. Vanita Jassal
  • Jane E. Brissenden
  • Alan Raisbeck
  • Jane M. Roscoe
Article

Abstract

Objective: To investigate the cost and quality of life associated with the first specialized chronic care facility for disabled dialysis patients. Design: A case controlled study in dialysis patients admitted to a specialized chronic dialysis unit (RCDU). Setting: The study compares the cost of care in a specialized chronic care facility with that of a tertiary hospital. Patients: All dialysis patients with severe chronic disability, resident in Greater Toronto, who were unable to be discharged into the community and who were admitted to the RCDU in the first year of the program. Interventions: Chronic care and rehabilitation services in a specialized dialysis unit. Outcome measures: Costs are expressed as $Cdn per patient year. Quality of life scores were measured using SIP and SF-36 questionnaires. Results: The data show a saving of $37 022 Cdn over the 618 day study period with care in the RCDU compared with that of a tertiary hospital. Quality of life measures show no difference in scores. Conclusions: We conclude that this preliminary report confirms a cost benefit of a specialized chronic care dialysis unit.

cost analysis chronic care hemodialysis quality of life rehabilitation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Canadian Society of Nephrology Annual Debate. Controversies in Nephrology: Transplantation in the Elderly. New Orleans, November 1996.Google Scholar
  2. 2.
    Anderson JE, Kraus J, Sturgeon D. Incidence, prevalence, and outcomes of end-stage renal disease patients placed in nursing homes. Am J Kidney Dis 1993; 21: 619-627.PubMedGoogle Scholar
  3. 3.
    Brunner FP, Selwood NH. Profile of patients on RRT in Europe and death rates due to major causes of death groups. The EDTA Registration Committee. Kidney Int-Supplement 1992; 38: S4-15.Google Scholar
  4. 4.
    D'Amico G, Striker GE. Proceedings from the symposium on renal replacement therapy throughout the world: the registries. Comparability of the different registries on renal replacement therapy. Am J Kidney Dis 1995; 25: 113-118.PubMedGoogle Scholar
  5. 5.
    Ifudu O, Paul H, Mayers JD, Cohen LS, Brezsnyak WF, Herman AI, Avram MM, Freidman EA. Pervasive failed rehabilitation in center-based maintenance hemodialysis patients. Am J Kidney Dis 1994; 23: 394-400.PubMedGoogle Scholar
  6. 6.
    Ifudu O, Mayers J, Matthew J, Tan CC, Cambridge A, Freidman EA. Dismal rehabilitation in geriatric inner-city hemodialysis patients. JAMA 1994; 271: 29-33.PubMedCrossRefGoogle Scholar
  7. 7.
    Ismail N, Hakim RM, Oreopoulos DG, Patrikarea A. Renal replacement therapies in the elderly: Part 1. Hemodialysis and chronic peritoneal dialysis. Am J Kidney Dis 1993; 22: 759-782.PubMedGoogle Scholar
  8. 8.
    Mallick NP, Jones E, Selwood N. The European (European Dialysis and Transplantation Association-European Renal Association) Registry. Am J Kidney Dis 1995; 25: 176-188.PubMedGoogle Scholar
  9. 9.
    Port FK. Worldwide demographics and future trends in end stage renal disease. Kidney Int Suppl 1993; 41: S4-S7.PubMedGoogle Scholar
  10. 10.
    MTDHC Hospital Restructuring Project. Nephrological services taskforce workbook. Metropolitan Toronto District Health Council, Ontario. Ministry of Health. September 1994.Google Scholar
  11. 11.
    Roscoe JM. Haemodialysis in a chronic care facility, in Oreopoulos DG, Michelis MF, Herscorn S. (eds): Nephrology and Urology in the Aged Patient. Dordrecht, Kluwer Academic Publishers 1993; 219-224.Google Scholar
  12. 12.
    Jassal SV, Brissenden JE, Roscoe JM. Specialized Chronic Care for Dialysis Patients-a Five Year Study. Clin Nephrol 1998 (in press).Google Scholar
  13. 13.
    . Ontario Ministry of Health. Schedule of Benefits. Physician Services under the Health Insurance Act Toronto, Ministry of Health, 1991.Google Scholar
  14. 14.
    Ware JE, Snow KK, Kosinski M et al. SF-36 Health Survey: Manual and Interpretation Guide. Boston Mass, The Health Institute, 1993.Google Scholar
  15. 15.
    Bergner M, Bobbitt R, Carter WB, Gilson BS. The sickness impact profile: development and final revision of a health status measure. Med Care 1981; 19: 787-805.PubMedGoogle Scholar
  16. 16.
    Drummond MF, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. Oxford, Oxford Medical Publications, 1992.Google Scholar
  17. 17.
    Hull AR, Hirsh J, Sackett DL, Stoddart GL. Cost-effectiveness of primary and secondary prevention of pulmonary embolism in high-risk surgical patients. CMAJ 1982; 127: 990-995.Google Scholar
  18. 18.
    Harwood RH, Ebrahim S. Is relocation harmful to institutionalized elderly people? Age and Ageing 1992; 21: 61-66.PubMedGoogle Scholar
  19. 19.
    Hallewell C, Morris J, Jolley D. The closure of residential homes: What happens to residents. Age and Ageing 1994; 23: 158-61.PubMedGoogle Scholar
  20. 20.
    Craven JL, Rodin GM, Littlefield C. The Beck depression inventory as a screening device for major depression in renal dialysis patients. Int J Psychiartry in Med 1988; 18: 365-374.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • S. Vanita Jassal
    • 1
  • Jane E. Brissenden
    • 1
  • Alan Raisbeck
    • 1
  • Jane M. Roscoe
    • 1
  1. 1.Wellesley HospitalTorontoCanada

Personalised recommendations