Open Access Highly Accessed Study protocol

Rationale for a home dialysis virtual ward: design and implementation

Michael E Schachter1, Joanne M Bargman1, Michael Copland3, Michelle Hladunewich5, Karthik K Tennankore2, Adeera Levin4, Matthew Oliver5, Robert P Pauly6, Jeffrey Perl7, Deborah Zimmerman8 and Christopher T Chan1*

Author Affiliations

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

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BMC Nephrology 2014, 15:33  doi:10.1186/1471-2369-15-33

Published: 14 February 2014

Abstract

Background

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.

Methods/design

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.

Discussion

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.

Trial registration

(NCT01912001).

Keywords:
Virtual ward; Home dialysis; Patient support; Hospital-avoidance; Peritoneal dialysis; Home hemodialysis; Re-admission; Technique survival; Patient satisfaction