Study of Home-Embedded Palliative Care for Hemodialysis-Dependent End-Stage Renal Disease
Study of Home-Embedded Palliative Care for Hemodialysis-Dependent End-Stage Renal Disease
Home palliative care needs are often under-recognized in patients with End-Stage Renal Disease (ESRD). This pilot study is designed to evaluate the feasibility and acceptability of an initiative to enhance referrals to Penn Home Palliative Care compared with usual care among hemodialysis-dependent ESRD patients admitted to a Penn hospital. Results will inform a future pragmatic trial comparing the effectiveness of home palliative care compared with usual care among ESRD patients. Evaluating the effectiveness of home palliative care services is critical to determine whether increasing access to these services would improve patient-centered outcomes for these high-need patients.
Inclusion Criteria:
Be an adult (18 years of age or older) hospitalized at one of two study hospitals
Digital signature of ESRD (N18.6) within the last 12 months with an inpatient hemodialysis order
Patient resides in the five-county area surrounding Philadelphia which is served by the Penn Home Palliative Care services.
Appropriate for home palliative care, defined as:
(i) Existing home care eligibility/referral for home care OR (ii) Severe protein malnutrition (E43, E44) OR (iii) Non-ambulatory status determined by a flowsheet completed by nursing on hospital admission with three ambulatory options: (1) non-ambulatory, (2) ambulates with assistance, or (3) ambulates independently. If this information is missing from the electronic health record, the determination will be made using one of the three following options: (1) overall prior home mobility assessment "complete dependence on all aspects," or (2) ambulation or functional transfers domains indicate "dependent," or (3) wheelchair mobility domain was completed (with any non-null/non-empty value).
Exclusion Criteria: