Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK)
Introduction: Multidisciplinary care (MDC) for late-stage chronic kidney disease (CKD) has been associated with improved patient outcomes compared with traditional nephrology care; however, the optimal MDC model is unknown. In 2015, we implemented a novel MDC model for patients with late-stage CKD i...
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Elsevier
2024-10-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924018485 |
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| author | Daniil Shimonov Sri Lekha Tummalapalli Stephanie Donahue Vidya Narayana Sylvia Wu Lisa S. Walters Roberta Billman Barbara Desiderio Sandra Pressman Oliver Fielding Kariel Sweeney Daniel Cukor Daniel M. Levine Thomas S. Parker Vesh Srivatana Jeffrey Silberzweig Frank Liu Andrew Bohmart |
| author_facet | Daniil Shimonov Sri Lekha Tummalapalli Stephanie Donahue Vidya Narayana Sylvia Wu Lisa S. Walters Roberta Billman Barbara Desiderio Sandra Pressman Oliver Fielding Kariel Sweeney Daniel Cukor Daniel M. Levine Thomas S. Parker Vesh Srivatana Jeffrey Silberzweig Frank Liu Andrew Bohmart |
| author_sort | Daniil Shimonov |
| collection | DOAJ |
| description | Introduction: Multidisciplinary care (MDC) for late-stage chronic kidney disease (CKD) has been associated with improved patient outcomes compared with traditional nephrology care; however, the optimal MDC model is unknown. In 2015, we implemented a novel MDC model for patients with late-stage CKD informed by the Chronic Care Model conceptual framework, including an expanded MDC team, care plan meetings, clinical risk prediction, and a patient dashboard. Methods: We conducted a single-center, retrospective cohort study of adults with late-stage CKD (estimated glomerular filtration rate [eGFR] < 30 ml/min per 1.73 m2) enrolled from May 2015 to February 2020 in the Program for Education in Advanced Kidney Disease (PEAK). Our primary composite outcome was an optimal transition to end-stage kidney disease (ESKD) defined as starting in-center hemodialysis (ICHD) as an outpatient with an arteriovenous fistula (AVF) or graft (AVG), or receiving home dialysis, or a preemptive kidney transplant. Secondary outcomes included home dialysis initiation, preemptive transplantation, vascular access at dialysis initiation, and location of ICHD initiation. We used logistic regression to examine trends in outcomes. Results were stratified by race, ethnicity, and insurance payor, and compared with national and regional averages from the United States Renal Data System (USRDS) averaged from 2015 to 2019. Results: Among 489 patients in the PEAK program, 37 (8%) died prior to ESKD and 151 (31%) never progressed to ESKD. Of the 301 patients (62%) who progressed to ESKD, 175 (58%) achieved an optimal transition to ESKD, including 54 (18%) on peritoneal dialysis, 16 (5%) on home hemodialysis, and 36 (12%) to preemptive transplant. Of the 195 patients (65%) starting ICHD, 51% started with an AVF or AVG and 52% started as an outpatient. The likelihood of starting home dialysis increased by 1.34 times per year from 2015 to 2020 (95% confidence interval [CI]: 1.05–1.71, P = 0.018) in multivariable adjusted results. Optimal transitions to ESKD and home dialysis rates were higher than the national USRDS data (58% vs. 30%; 23% vs. 11%) across patient race, ethnicity, and payor. Conclusion: Patients enrolled in a novel comprehensive MDC model coupled with risk prediction and health information technology were nearly twice as likely to achieve an optimal transition to ESKD and start dialysis at home, compared with national averages. |
| format | Article |
| id | doaj-art-2ef2e4eee8f44c2f80225bcc3d6261c3 |
| institution | OA Journals |
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| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
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| series | Kidney International Reports |
| spelling | doaj-art-2ef2e4eee8f44c2f80225bcc3d6261c32025-08-20T02:33:36ZengElsevierKidney International Reports2468-02492024-10-019102904291410.1016/j.ekir.2024.07.018Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK)Daniil Shimonov0Sri Lekha Tummalapalli1Stephanie Donahue2Vidya Narayana3Sylvia Wu4Lisa S. Walters5Roberta Billman6Barbara Desiderio7Sandra Pressman8Oliver Fielding9Kariel Sweeney10Daniel Cukor11Daniel M. Levine12Thomas S. Parker13Vesh Srivatana14Jeffrey Silberzweig15Frank Liu16Andrew Bohmart17The Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USA; Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USANew York Quality Care, New York-Presbyterian, New York, New York, USADivision of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USAThe Rogosin Institute, New York, New York, USAThe Rogosin Institute, New York, New York, USAThe Rogosin Institute, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USA; Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; New York Quality Care, New York-Presbyterian, New York, New York, USA; Oliver Fielding is an independent contractor; Department of Biochemistry, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USAThe Rogosin Institute, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Department of Biochemistry, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Department of Biochemistry, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USAThe Rogosin Institute, New York, New York, USA; Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, New York, USA; Correspondence: Andrew Bohmart, Rogosin Manhattan East Dialysis, 505 East 70th Street New York, New York 10021, USA.Introduction: Multidisciplinary care (MDC) for late-stage chronic kidney disease (CKD) has been associated with improved patient outcomes compared with traditional nephrology care; however, the optimal MDC model is unknown. In 2015, we implemented a novel MDC model for patients with late-stage CKD informed by the Chronic Care Model conceptual framework, including an expanded MDC team, care plan meetings, clinical risk prediction, and a patient dashboard. Methods: We conducted a single-center, retrospective cohort study of adults with late-stage CKD (estimated glomerular filtration rate [eGFR] < 30 ml/min per 1.73 m2) enrolled from May 2015 to February 2020 in the Program for Education in Advanced Kidney Disease (PEAK). Our primary composite outcome was an optimal transition to end-stage kidney disease (ESKD) defined as starting in-center hemodialysis (ICHD) as an outpatient with an arteriovenous fistula (AVF) or graft (AVG), or receiving home dialysis, or a preemptive kidney transplant. Secondary outcomes included home dialysis initiation, preemptive transplantation, vascular access at dialysis initiation, and location of ICHD initiation. We used logistic regression to examine trends in outcomes. Results were stratified by race, ethnicity, and insurance payor, and compared with national and regional averages from the United States Renal Data System (USRDS) averaged from 2015 to 2019. Results: Among 489 patients in the PEAK program, 37 (8%) died prior to ESKD and 151 (31%) never progressed to ESKD. Of the 301 patients (62%) who progressed to ESKD, 175 (58%) achieved an optimal transition to ESKD, including 54 (18%) on peritoneal dialysis, 16 (5%) on home hemodialysis, and 36 (12%) to preemptive transplant. Of the 195 patients (65%) starting ICHD, 51% started with an AVF or AVG and 52% started as an outpatient. The likelihood of starting home dialysis increased by 1.34 times per year from 2015 to 2020 (95% confidence interval [CI]: 1.05–1.71, P = 0.018) in multivariable adjusted results. Optimal transitions to ESKD and home dialysis rates were higher than the national USRDS data (58% vs. 30%; 23% vs. 11%) across patient race, ethnicity, and payor. Conclusion: Patients enrolled in a novel comprehensive MDC model coupled with risk prediction and health information technology were nearly twice as likely to achieve an optimal transition to ESKD and start dialysis at home, compared with national averages.http://www.sciencedirect.com/science/article/pii/S2468024924018485chronic care modelhealth information technologyhome dialysislate-stage chronic kidney diseasemultidisciplinary careoptimal starts |
| spellingShingle | Daniil Shimonov Sri Lekha Tummalapalli Stephanie Donahue Vidya Narayana Sylvia Wu Lisa S. Walters Roberta Billman Barbara Desiderio Sandra Pressman Oliver Fielding Kariel Sweeney Daniel Cukor Daniel M. Levine Thomas S. Parker Vesh Srivatana Jeffrey Silberzweig Frank Liu Andrew Bohmart Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK) Kidney International Reports chronic care model health information technology home dialysis late-stage chronic kidney disease multidisciplinary care optimal starts |
| title | Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK) |
| title_full | Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK) |
| title_fullStr | Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK) |
| title_full_unstemmed | Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK) |
| title_short | Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK) |
| title_sort | clinical outcomes of a novel multidisciplinary care program in advanced kidney disease peak |
| topic | chronic care model health information technology home dialysis late-stage chronic kidney disease multidisciplinary care optimal starts |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924018485 |
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