New clinic trial
Joined: 14 Apr 2003
Posts: 1
Posted: Mon Apr 14, 2003 11:37 am Post subject: Intervention can greatly improve dialysis treatment
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Intervention can greatly improve dialysis treatment<
> Contact George Stamatis, 216-368-3635 or gxs18@po.cwru.edu <
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> A new clinical trial demonstrates that identifying and overcoming three barriers greatly improves<
> the quality of hemodialysis treatment, a finding that may help the 33,000 Americans now receiving<
> suboptimal doses of hemodialysis. <
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> According to an article in the April 17 issue of The Journal of the American Medical<
> Association (JAMA), the three barriers are under-prescription of dialysis by physicians, use of<
> intravenous catheters to provide treatment and shortening of treatment time by patients. The<
> randomized controlled trial showed that educating physicians and patients about these barriers<
> resulted in a two-fold larger increase in dialysis dose compared to conventional care. <
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> The study's method of identifying and overcoming barriers to quality care may also be applicable<
> to other chronic conditions such as asthma or heart disease. <
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> Virtually all dialysis treatment is paid for by Medicare, even for patients younger than 65 years<
> old. Despite annual federal expenditures of $18 billion, the mortality rate among American<
> hemodialysis patients is the highest in the industrialized world at 23 percent per year. European<
> and Japanese hemodialysis patient mortality rates are much lower at 10 to15 percent per year. <
><
> The high mortality rate among American patients is in part due to the fact that one-sixth of the<
> 200,000 Americans receiving hemodialysis treatment do not receive an adequate dialysis dose.<
> Hemodialysis is used to treat people with kidney failure. In the process, blood is removed from<
> the body and pumped into a machine that filters out toxic substances from the blood and then<
> returns the purified blood to the person.<
><
> The researchers, led by Ashwini Sehgal from the School of Medicine identified three barriers to<
> adequate dialysis, showed that it is possible to overcome the barriers and demonstrated that<
> overcoming barriers resulted in higher quality treatment. <
><
> The study, involving 169 patients from 29 hemodialysis facilities, identified and addressed each<
> barrier separately. If dialysis prescriptions were too low, a study coordinator helped physicians<
> improve the prescriptions. If patients received treatment through a catheter, the study coordinator<
> helped patients get grafts or fistulas instead. A graft or fistula is a surgically created connection<
> between an artery and a vein that provides a better blood flow for dialysis. If patients shortened<
> treatment time by coming late or leaving early, the study coordinator educated them about the<
> importance of staying for their full treatment time.<
><
> "Dialysis is similar to drugs in that both must be given at an appropriate dose to be effective," said<
> Sehgal. "Patients getting an inadequate dialysis dose die sooner and are hospitalized more often." <
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> The federal reimbursement system, which provides a fixed payment per treatment, may act as a<
> financial disincentive to providing high quality treatment. <
><
> "Using higher efficiency machines or increasing treatment time costs money, but facilities don't get<
> paid more for these higher costs,""said Sehgal. "I urge patients to stay for their full treatment time,"<
> said Sehgal. "I urge physicians and dialysis facilities to address the three barriers we identified. I<
> urge policy makers to re-examine how we pay for dialysis treatment." <
><
> The cost of carrying out the intervention was very modest because a single study coordinator<
> educated physicians and patients. Similar inexpensive interventions might be developed to identify<
> and overcome barriers to quality care in other medical areas, said Sehgal. <
><
> Sehgal is an associate professor of medicine, biomedical ethics, and epidemiology and biostatistics<
> at CWRU and a member of the Division of Nephrology at MetroHealth Medical Center in<
> Cleveland. <
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> ?CWRU?<
