Background Patients with ESRD comprise less than 1% of the Medicare population, however they are responsible for 7% of all Medicare spending. Hemodialysis (HD) and peritoneal dialysis (PD) have equivalent clinical outcomes; however, PD is more cost-effective. Undocumented immigrants, when given access to dialysis, are suspected to have lower PD utilization.
Objectives Establish baseline PD utilization rates amongst patients stratified by funding status, design an intervention to improve PD utilization, and assess impacts of interventions on utilization rates.
Methods The intervention was designed by using interview data to identify patient and provider barriers to selection of PD and stratifying the top failure causes through failure modes and effects analysis (figure 1). PD utilization rates before and after the intervention were determined through a retrospective chart review. The impact of the intervention on patient understanding was assessed with patient surveys.
Results The chosen intervention was to revise educational materials to address common misconceptions. Prior to the class update, the utilization rate for PD was 14.3% in the non-traditionally funded group, primarily containing undocumented immigrants, compared to a 21.0% utilization rate in the traditionally funded group. After the updated class was implemented, PD utilization in increased to 26.1% and 22.9% in the non-traditionally and traditionally funded groups, respectively (figure 2–4). Preliminary data from post-class patient surveys suggests that patients with a better understanding of class material are more likely to make an earlier selection of a dialysis modality.
Conclusions Addressing patient misconceptions about peritoneal dialysis by updating educational materials is an intervention that can increase the utilization rates of PD in patients with non-traditional funding. External factors could have played a role in increased PD utilization and additional data is needed to establish a more robust correlation.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.