An integrated dialysis delivery network in Ontario.

In August 1995, the Ontario Ministry of Health (MOH) issued a request for proposal (RFP) for the establishment of new and expanded dialysis services. London Health Sciences Centre (LHSC) was successful in expanding its integrated dialysis delivery network with satellites in Stratford, Woodstock and Owen Sound. This achievement required collaboration of LHSC and host hospital staff to meet the challenging RFP requirements. With final approval received in January 1997, efforts were required to establish an operational model supporting self-care and full-care patients, to train satellite staff and patients, and to manage the resulting clinical impact. A balanced scorecard (Kaplan & Norton, 1992) evaluation model was developed. Initial outcome data indicate that full-care patients in satellites require more fallback support to London units, experience more hypotensive episodes during dialysis and, in some cases, demonstrate lower levels of dialysis adequacy and nutritional status when compared to satellite self-care patients. Findings from these data will assist in revising patient inclusion criteria and processes to optimize community-based dialysis.