Simple intervention improves quality of dialysis treatment

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.

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 dont 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.


Contact: George Stamatis
Case Western Reserve University

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