Fresenius Medical Care Sees US Plans for Kidney Disease as Positive
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Moving the model of care for dialysis patients towards more pervasive observation, assistance and support of patient decision making is vital. Patient-centered care that helps dialysis patients make wise decisions in their daily lives will significantly improve their outcomes and experiences.
In his commentary, Dr. Maddux identifies ten action steps that can fundamentally improve the care of patients with kidney disease by enhancing the quality, safety and efficiency of the healthcare system. Achieving these goals will not only help providers give better care, but engage patients in their own care, both of which will increase the likelihood of success in achieving positive health goals and improving quality of life. Among these key actions are:
Putting the patient at the center of care: Traditionally, physicians and health providers were primarily responsible for determining what was deemed best for their patients. While their expertise regarding appropriate treatment and care remains vital, there is an increasing and necessary focus on understanding and incorporating a patient’s values, goals, aspirations and needs into the calculus of delivering care. In other words, it is crucial to base care – and expand the definition of quality care – to include the patient’s perspective. Therefore, patient perspectives should be considered regarding:
Improving technology to enable better care: New technology can go a long way toward giving physicians and providers vital information about the condition of their patients. It can also give patients important information about their own health. As a result, Dr. Maddux suggests researchers and providers should:
Measuring what really matters: Outcomes should reflect reality by looking at the big picture. Measuring what really matters means factoring in not only the outcomes of the type of care patients receive, but decisions and barriers that led to the method of care. For example, the preferred method for receiving dialysis is through a fistula, in which physicians surgically create access using the patient’s own blood vessels. But because a fistula takes time to heal and mature, the surgery should take place with adequate time and preparation before the patient may require dialysis. Because many things can slow down that process – from a delay in surgical evaluation to an extended period of healing and maturation of the fistula – those factors should be tracked as well.
Using information to head off a crisis: Intensive use of information and data can help in the development of clinical insights providers can use to intervene before a known health crisis occurs. Nutrition is a good place to start. For example, the traditional standard is to wait until a patient’s albumin (a type of blood protein) is quite low before responding. At that point, the body’s ability to retain its nutritional competence may be compromised. A better path would be to identify patients who are not obtaining enough nutrients and consider prescribing supplements to selected patients in need to prevent a crisis of nutritional decline.
“Improving outcomes is really about involving patients in their own care, from helping them understand the choices they make matter, to determining what success based on shared goals looks like with their care teams,” said Dr. Maddux. “Research shows that patients empowered to participate in their care live longer, consume fewer resources and have an enhanced quality of life.”
Maddux FW. Doing more than caring about quality? Semin Dial. 2016; Feb. 9. doi: 10.1111/sdi.12471. [Epub ahead of print]