Rationale for a home dialysis virtual ward: design and implementation
1 Department of Medicine, Division of Nephrology, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
2 Department of Medicine, Division of Nephrology, QEII Health Sciences Centre, 5820 University Avenue, Halifax, NS B3H 1V7, Canada
3 Department of Medicine, Division of Nephrology, Vancouver General Hospital, University of British Columbia, 855 12th Avenue W, Vancouver, BC V5Z 1M9, Canada
4 Department of Medicine, Division of Nephrology, St Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
5 Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
6 Department of Medicine, Division of Nephrology & Transplantation Immunology, University of Alberta, 11-107 Clinical Sciences Building, 8440, 112th Street, Edmonton, AB T6G 2G3, Canada
7 Department of Medicine, Division of Nephrology, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
8 Department of Medicine, Division of Nephrology, Ottawa Hospital, University of Ottawa, 1967 Riverside Drive Ottawa, Ottawa, ON K1H 7W9, Canada
BMC Nephrology 2014, 15:33 doi:10.1186/1471-2369-15-33Published: 14 February 2014
Home-based renal replacement therapy (RRT) [peritoneal dialysis (PD) and home hemodialysis (HHD)] offers independent quality of life and clinical advantages compared to conventional in-center hemodialysis. However, follow-up may be less complete for home dialysis patients following a change in care settings such as post hospitalization. We aim to implement a Home Dialysis Virtual Ward (HDVW) strategy, which is targeted to minimize gaps of care.
The HDVW Pilot Study will enroll consecutive PD and HHD patients who fulfilled any one of our inclusion criteria: 1. following discharge from hospital, 2. after interventional procedure(s), 3. prescription of anti-microbial agents, or 4. following completion of home dialysis training. Clinician-led telephone interviews are performed weekly for 2 weeks until VW discharge. Case-mix (modified Charlson Comorbidity Index), symptoms (the modified Edmonton Symptom Assessment Scale) and patient satisfaction are assessed serially. The number of VW interventions relating to eight pre-specified domains will be measured. Adverse events such as re-hospitalization and health-services utilization will be ascertained through telephone follow-up after discharge from the VW at 2, 4, 12 weeks. The VW re-hospitalization rate will be compared with a contemporary cohort (matched for age, gender, renal replacement therapy and co-morbidities). Our protocol has been approved by research ethics board (UHN: 12-5397-AE). Written informed consent for participation in the study will be obtained from participants.
This report serves as a blueprint for the design and implementation of a novel health service delivery model for home dialysis patients. The major goal of the HDVW initiative is to provide appropriate and effective supports to medically complex patients in a targeted window of vulnerability.