End-of-Life Care Among Patients With Kidney Failure on Maintenance Dialysis: A Retrospective Population-Based Study.

IF 1.6 Q3 UROLOGY & NEPHROLOGY Canadian Journal of Kidney Health and Disease Pub Date : 2024-09-21 eCollection Date: 2024-01-01 DOI:10.1177/20543581241280698
Shuaib Hafid, Sarina R Isenberg, Aleisha Fernandes, Erin Gallagher, Colleen Webber, Meera Joseph, Manish M Sood, Adrianna Bruni, Janet L Davis, Grace Warmels, James Downar, Anastasia Gayowsky, Aaron Jones, Doug Manuel, Peter Tanuseputro, Michelle Howard
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Abstract

Background: Nephrologists routinely provide end-of-life care for patients with kidney failure (KF) on maintenance dialysis. Involvement of primary care and palliative care physicians may enhance this experience.

Objective: The objective was to describe outpatient care patterns in the last year of life and the end-of-life acute care utilization for patients with KF on maintenance dialysis.

Design: Retrospective cohort study using population-level health administrative data.

Setting & participants: Outpatient and inpatient care during the last year of life among patients who died between 2017 and 2019, receiving maintenance dialysis in Ontario, Canada.

Measurements: The primary exposure is patterns of physician specialties providing outpatient care in the last year of life. Outcomes include outpatient encounters in the last year of life, acute care visitation in the last month of life, and place of death.

Methods: We reported the count and percentage of categorical outcomes and the median (interquartile range) for numeric outcomes. We produced time series plots of the mean monthly percentage of encounters to different specialties stratified by physician specialty patterns. We evaluated differences in outcomes by physician specialty patterns using analysis of variance (ANOVA) and Pearson's chi-square tests (P < .05, two-tailed).

Results: Among 6866 patients, the median age at death was 73, 36.1% were female, and 87.8% resided in urban regions. Three patterns emerged: a primary care, nephrology, and palliative care triad (25.5%); a primary care and nephrology dyad (59.3%); and a non-primary care pattern (15.2%). Palliative care involvement is concentrated near death. Of all, 81.4% spent at least 1 day in hospital or emergency department in the last month, but those with primary care, palliative care, and nephrology involvement had the fewest acute care deaths (65.8%).

Limitations: Outpatient care patterns were defined using physician billing codes, potentially missing care from other providers.

Conclusions: Nephrology and primary care predominantly manage outpatient care in the last year of life for patients with KF on maintenance dialysis, with consistent acute care use across care patterns except for the place of death. Future research should explore associations between patterns of care and end-of-life outcomes to identify the most optimal model of care for patients with KF on maintenance dialysis.

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维持性透析肾衰竭患者的临终关怀:一项基于人群的回顾性研究。
背景:肾脏科医生经常为接受维持性透析的肾衰竭(KF)患者提供临终关怀。初级保健和姑息治疗医生的参与可能会改善这种体验:目的:描述维持性透析的肾衰竭患者生命最后一年的门诊护理模式以及临终急症护理的使用情况:设计:使用人群健康管理数据进行回顾性队列研究:2017年至2019年期间在加拿大安大略省接受维持性透析的死亡患者生命最后一年的门诊和住院护理:主要暴露对象是在生命最后一年提供门诊护理的专科医师模式。结果包括生命最后一年的门诊就诊情况、生命最后一个月的急诊就诊情况以及死亡地点:我们报告了分类结果的计数和百分比,以及数字结果的中位数(四分位间距)。我们制作了不同专科每月平均就诊百分比的时间序列图,并按医生专科模式进行了分层。我们使用方差分析(ANOVA)和皮尔森卡方检验(P < .05,双尾)评估了不同专科医生模式的结果差异:在 6866 名患者中,死亡年龄中位数为 73 岁,36.1% 为女性,87.8% 居住在城市地区。出现了三种模式:初级医疗、肾脏内科和姑息治疗三合一(25.5%);初级医疗和肾脏内科二合一(59.3%);以及非初级医疗模式(15.2%)。姑息关怀的参与主要集中在临近死亡时。其中,81.4%的患者在上个月至少在医院或急诊科住院1天,但有初级医疗、姑息治疗和肾内科参与的患者在急诊科死亡的人数最少(65.8%):局限性:门诊护理模式是根据医生账单代码定义的,可能会遗漏其他医疗服务提供者提供的护理:肾脏内科和初级医疗机构主要负责维持性透析的 KF 患者生命最后一年的门诊护理,除死亡地点外,其他护理模式均使用急症护理。未来的研究应探索护理模式与生命末期结果之间的关联,以确定维持性透析的 KF 患者的最佳护理模式。
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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
84
审稿时长
12 weeks
期刊介绍: Canadian Journal of Kidney Health and Disease, the official journal of the Canadian Society of Nephrology, is an open access, peer-reviewed online journal that encourages high quality submissions focused on clinical, translational and health services delivery research in the field of chronic kidney disease, dialysis, kidney transplantation and organ donation. Our mandate is to promote and advocate for kidney health as it impacts national and international communities. Basic science, translational studies and clinical studies will be peer reviewed and processed by an Editorial Board comprised of geographically diverse Canadian and international nephrologists, internists and allied health professionals; this Editorial Board is mandated to ensure highest quality publications.
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