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Role of interventional nephrology in the multidisciplinary approach to hemodialysis vascular access care.

Beathard GA - Kidney Res Clin Pract (2015)

Bottom Line: Most of these interventional nephrologists work in freestanding outpatient dialysis access centers (DACs).Large clinical studies published over the past 10 years demonstrate that the interventional nephrologist can manage the problems associated with dialysis access dysfunction effectively, safely, and economically.A recently published study based upon United States Medicare claims data in which a DAC patient group (n = 27,613) and a hospital outpatient department patient group (HOPD group; n = 27,613) were compared using propensity score matching techniques showed that patients treated in the DACs had significantly better clinical outcomes (P<0.001).

View Article: PubMed Central - PubMed

Affiliation: University of Texas Medical Branch and Lifeline Vascular Access, Houston, Texas, USA.

ABSTRACT
Dialysis vascular access planning, creation, and management is of critical importance to the dialysis patient population. It requires a multidisciplinary approach involving patients and their families, dialysis facility staff, the nephrologist, the surgeon, and the interventionalist. With the emergence of interventional nephrology as a subspecialty of nephrology, the nephrologist is increasingly providing both the nephrology and interventional aspects of care, and in some areas, the surgical functions as well. Most of these interventional nephrologists work in freestanding outpatient dialysis access centers (DACs). Large clinical studies published over the past 10 years demonstrate that the interventional nephrologist can manage the problems associated with dialysis access dysfunction effectively, safely, and economically. A recently published study based upon United States Medicare claims data in which a DAC patient group (n = 27,613) and a hospital outpatient department patient group (HOPD group; n = 27,613) were compared using propensity score matching techniques showed that patients treated in the DACs had significantly better clinical outcomes (P<0.001). This included fewer vascular access-related infections (0.18 vs. 0.29), fewer septicemia-related hospitalizations (0.15 vs. 0.18), and a lower mortality rate (47.9% vs. 53.5%).

No MeSH data available.


Related in: MedlinePlus

Clinical value and economy of DACs. Scale is relative, see the text for actual values; for all values, P≤0.01.DAC, dialysis access center; HOPD, hospital outpatient department.From “Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries,” by A. Dobson, A.M. El-Gamil, M.T. Shimer, J.E. DaVanzo, A.Q. Urbanes, G.A. Beathard, T.F. Litchfield, 2013, Semin Dial, 26, p. 624–632. Reprinted with permission (Copyright - 2013. Copy right holder - Seminars in Dialysis).
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f0010: Clinical value and economy of DACs. Scale is relative, see the text for actual values; for all values, P≤0.01.DAC, dialysis access center; HOPD, hospital outpatient department.From “Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries,” by A. Dobson, A.M. El-Gamil, M.T. Shimer, J.E. DaVanzo, A.Q. Urbanes, G.A. Beathard, T.F. Litchfield, 2013, Semin Dial, 26, p. 624–632. Reprinted with permission (Copyright - 2013. Copy right holder - Seminars in Dialysis).

Mentions: To evaluate the overall clinical effect of a DAC, US Medicare claims data were collected representing incident and prevalent ESRD patients who received at least 80% of their dialysis vascular access management at either a DAC or a hospital outpatient department over a 4-year period [29]. Using propensity score matching techniques [30], cases with a similar clinical and demographic profile from these two sites of service were matched according to 47 different variables. Medicare utilization, payments, and patient outcomes were compared across the matched cohorts. This created a DAC group (n = 27,613) and an hospital outpatient department (HOPD) group (n = 27,613) for comparisons. Patients treated in the DAC (Fig. 2) had significantly better clinical outcomes (P≤0.001). This included fewer vascular access-related infections (0.18 vs. 0.29) and fewer septicemia-related hospitalizations (0.15 vs. 0.18). Mortality rate was lower (47.9% vs. 53.5%).


Role of interventional nephrology in the multidisciplinary approach to hemodialysis vascular access care.

Beathard GA - Kidney Res Clin Pract (2015)

Clinical value and economy of DACs. Scale is relative, see the text for actual values; for all values, P≤0.01.DAC, dialysis access center; HOPD, hospital outpatient department.From “Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries,” by A. Dobson, A.M. El-Gamil, M.T. Shimer, J.E. DaVanzo, A.Q. Urbanes, G.A. Beathard, T.F. Litchfield, 2013, Semin Dial, 26, p. 624–632. Reprinted with permission (Copyright - 2013. Copy right holder - Seminars in Dialysis).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608876&req=5

f0010: Clinical value and economy of DACs. Scale is relative, see the text for actual values; for all values, P≤0.01.DAC, dialysis access center; HOPD, hospital outpatient department.From “Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries,” by A. Dobson, A.M. El-Gamil, M.T. Shimer, J.E. DaVanzo, A.Q. Urbanes, G.A. Beathard, T.F. Litchfield, 2013, Semin Dial, 26, p. 624–632. Reprinted with permission (Copyright - 2013. Copy right holder - Seminars in Dialysis).
Mentions: To evaluate the overall clinical effect of a DAC, US Medicare claims data were collected representing incident and prevalent ESRD patients who received at least 80% of their dialysis vascular access management at either a DAC or a hospital outpatient department over a 4-year period [29]. Using propensity score matching techniques [30], cases with a similar clinical and demographic profile from these two sites of service were matched according to 47 different variables. Medicare utilization, payments, and patient outcomes were compared across the matched cohorts. This created a DAC group (n = 27,613) and an hospital outpatient department (HOPD) group (n = 27,613) for comparisons. Patients treated in the DAC (Fig. 2) had significantly better clinical outcomes (P≤0.001). This included fewer vascular access-related infections (0.18 vs. 0.29) and fewer septicemia-related hospitalizations (0.15 vs. 0.18). Mortality rate was lower (47.9% vs. 53.5%).

Bottom Line: Most of these interventional nephrologists work in freestanding outpatient dialysis access centers (DACs).Large clinical studies published over the past 10 years demonstrate that the interventional nephrologist can manage the problems associated with dialysis access dysfunction effectively, safely, and economically.A recently published study based upon United States Medicare claims data in which a DAC patient group (n = 27,613) and a hospital outpatient department patient group (HOPD group; n = 27,613) were compared using propensity score matching techniques showed that patients treated in the DACs had significantly better clinical outcomes (P<0.001).

View Article: PubMed Central - PubMed

Affiliation: University of Texas Medical Branch and Lifeline Vascular Access, Houston, Texas, USA.

ABSTRACT
Dialysis vascular access planning, creation, and management is of critical importance to the dialysis patient population. It requires a multidisciplinary approach involving patients and their families, dialysis facility staff, the nephrologist, the surgeon, and the interventionalist. With the emergence of interventional nephrology as a subspecialty of nephrology, the nephrologist is increasingly providing both the nephrology and interventional aspects of care, and in some areas, the surgical functions as well. Most of these interventional nephrologists work in freestanding outpatient dialysis access centers (DACs). Large clinical studies published over the past 10 years demonstrate that the interventional nephrologist can manage the problems associated with dialysis access dysfunction effectively, safely, and economically. A recently published study based upon United States Medicare claims data in which a DAC patient group (n = 27,613) and a hospital outpatient department patient group (HOPD group; n = 27,613) were compared using propensity score matching techniques showed that patients treated in the DACs had significantly better clinical outcomes (P<0.001). This included fewer vascular access-related infections (0.18 vs. 0.29), fewer septicemia-related hospitalizations (0.15 vs. 0.18), and a lower mortality rate (47.9% vs. 53.5%).

No MeSH data available.


Related in: MedlinePlus