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This is an evaluation of a program developed by a team of nephrologists, operations experts and researchers. The goal is to provide CKD patients with a better way to transition to life on dialysis - one that emphasizes even more individual clinical, psychosocial and lifestyle needs. On top of high-quality clinical care, the 4-week Optimal Transition program supports patients as they adjust to treatment and learn to live the best life possible. This is done through a robust education curriculum and a trust-building approach.
In this program evaluation the investigators will be reporting on the following program outcomes:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Other | This program, which is provided for all patients new to dialysis at the participating units, will be evaluated by assessing patient clinical outcomes and the results of surveys measuring patient-reported symptoms, quality of life, knowledge and activation. In addition, satisfaction with the program will be assessed. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Analysis using descriptive statistics of patient clinical outcomes. | Other | Evaluation of the following:
|
| Measure | Description | Time Frame |
|---|---|---|
| Evaluation of clinical stabilization through standard clinical dialysis labs | Evaluation of changes in the Standard of care monthly dialysis labs | On admission, week 4 and day 90 |
| Evaluation of clinical stabilization through standard clinical dialysis blood pressure measurements | Evaluation of any changes in the Pre and post dialysis blood pressures for each patient which are collected as part of the patient's dialysis flow sheet. | At week one and week 4. |
| Evaluation of clinical stabilization through standard clinical dialysis measurements of Intradialytic blood pressures | Evaluation of any changes in the incidence of Intradialytic hypotension as assessed by review of the patient's dialysis flow sheet. | At week one and week 4. |
| Evaluation of clinical stabilization through standard clinical dialysis measurements of ultrafiltration | Evaluation of interval changes in the patient's ultrafiltration rates as measured by the dialysis machine and reported on the patient's dialysis flow sheets. | At week one, week 4, day 90, day 180 and day 360. |
| Evaluation of clinical stabilization through standard clinical dialysis measurements of weight | Target weight defined and achieved as measured by standard of care at the unit | At week one and week 4, and changes between week one and week 4. |
| Evaluation of clinical stabilization through standard clinical dialysis measurements | Dialysis access type as reported in the dialysis treatment sheets |
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Inclusion Criteria:
Exclusion Criteria:
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All patients referred by their treating nephrologist to one of the two Satellite Healthcare (SHC) participating centers who are new to dialysis and meet the inclusion/exclusion criteria.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jug Atwal | Contact | 650-404-3606 | atwalJ@satellitehealth.com | |
| Legg Veronica, M.S. | Contact | 650-404-3736 | leggv@satellitehealth.com |
| Name | Affiliation | Role |
|---|---|---|
| Wael F Hussein, MBBS | Satellite Healthcare, Inc. | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Satellite Healthcare Oakland | Recruiting | Oakland | California | 94609 | United States | |
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|
| Surveys with participants using validated survey tools. | Other | Surveys will assess participants' Symptom index, Quality of Life, Patient Activation as well as satisfaction with the program. |
|
| Evaluation of the program process including time, costs, referral rates, admission to the program and length of stay. | Other | Data will be collected using tracking tools throughout the program. |
|
| At week one and day 90 |
| Evaluation of clinical stabilization through standard clinical dialysis collection of patient hospitalizations. | Hospitalization rates as reported in the standard dialysis record for all patients | Day 30, day 90, 6 months and 12 months |
| Evaluation of clinical stabilization through standard clinical dialysis records. | Mortality rates as reported in the standard dialysis record for all patients | Day 30, day 90, 6 months and 12 months |
| Evaluation of clinical and psychological stabilization through a quality of life measurement. | The EQ-5D tool will be used | Week 4 |
| Evaluation of clinical and psychological stabilization through assessment of patient symptoms. | The ESAS-r:Renal tool will be used | Week 1 and Week 4 |
| Satisfaction with the modality options education | Survey of patient experience | Week 1 and Week 4 |
| Type of Dialysis Modality chosen by the patient | Dialysis modality choice as reported by the patient | Week 1 and Week 4 |
| Actual Type of Dialysis Modality used by the patient | Dialysis modality as reported on the standard dialysis treatment sheets | week 4, month 3, 6, 12, 18 and 24 |
| Evaluation of patient knowledge of dialysis and modalities | Weekly focused one on one discussion where the patient is questioned about his/her understanding of dialysis, his/her progress, questions, concerns using a questionnaire developed by the investigator | Week 1, 2, 3, 4 |
| Evaluation of patient activation | Survey measuring patient activation (PAM-13) survey | Week 3 and month 3 |
| Evaluation of patient satisfaction | Survey of satisfaction with the program | Week 4 or discharge from the program whichever comes first |
| Evaluation of the program process for time utilization | Time per patient for visits from program start to completion for each patient | Week 1 through week 4 |
| Evaluation of the program process for cost utilization | Time, and thus cost, for personnel to complete the program with each patient from entrance to completion or early termination. | Week 1 through week 4 |
| Evaluation of the feasibility of the program | Number of referrals to the program and subsequent number of admissions to the program. | Week 1 through week 4 |
| Evaluation of the program efficiency | Average length of stay for each patient in the program. | Week 1 through week 4 |
| Satellite Healthcare Sacramento |
| Recruiting |
| Sacramento |
| California |
| 95834 |
| United States |
| Satellite Healthcare Chickasaw Gardens | Recruiting | Memphis | Tennessee | 38111 | United States |
| ID | Term |
|---|---|
| D007676 | Kidney Failure, Chronic |
| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D011795 | Surveys and Questionnaires |
| D003365 | Costs and Cost Analysis |
| D007902 | Length of Stay |
| ID | Term |
|---|---|
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |
| D004467 | Economics |
| D004472 | Health Care Economics and Organizations |
| D006760 | Hospitalization |
| D005791 | Patient Care |
| D013812 | Therapeutics |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
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