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Implementation and Effectiveness of a Learning Collaborative to Improve Palliative Care for Seriously Ill Hemodialysis Patients

医学 血液透析 缓和医疗 重症监护医学 病危 病入膏肓 梅德林 护理部 内科学 政治学 法学
作者
Manjula Kurella Tamura,Laura M. Holdsworth,M. Stedman,Annette Aldous,Steven M. Asch,Jialin Han,Glenda Harbert,Karl Lorenz,Elizabeth Malcolm,Amanda Nicklas,Alvin H. Moss,Dale Lupu
出处
期刊:Clinical Journal of The American Society of Nephrology [American Society of Nephrology]
卷期号:17 (10): 1495-1505 被引量:5
标识
DOI:10.2215/cjn.00090122
摘要

Background and objectives Limited implementation of palliative care practices in hemodialysis may contribute to end-of-life care that is intensive and not patient centered. We determined whether a learning collaborative for hemodialysis center providers improved delivery of palliative care best practices. Design, setting, participants, & measurements Ten US hemodialysis centers participated in a pre-post study targeting seriously ill patients between April 2019 and September 2020. Three practices were prioritized: screening for serious illness, goals of care discussions, and use of a palliative dialysis care pathway. The collaborative educational bundle consisted of learning sessions, communication skills training, and implementation support. The primary outcome was change in the probability of complete advance care planning documentation among seriously ill patients. Health care utilization was a secondary outcome, and implementation outcomes of acceptability, adoption, feasibility, and penetration were assessed using mixed methods. Results One center dropped out due to the coronavirus disease 2019 pandemic. Among the remaining nine centers, 20% (273 of 1395) of patients were identified as seriously ill preimplementation, and 16% (203 of 1254) were identified as seriously ill postimplementation. From the preimplementation to postimplementation period, the adjusted probability of complete advance care planning documentation among seriously ill patients increased by 34.5 percentage points (95% confidence interval, 4.4 to 68.5). There was no difference in mortality or in utilization of palliative hemodialysis, hospice referral, or hemodialysis discontinuation. Screening for serious illness was widely adopted, and goals of care discussions were adopted with incomplete integration. There was limited adoption of a palliative dialysis care pathway. Conclusions A learning collaborative for hemodialysis centers spanning the coronavirus disease 2019 pandemic was associated with adoption of serious illness screening and goals of care discussions as well as improved documentation of advance care planning for seriously ill patients. Clinical Trial registry name and registration number: Pathways Project: Kidney Supportive Care, NCT04125537

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