Hub-and-spoke centers model of dialysis supported by cashless government scheme in a resource-poor setting: A successful model

Abstract

<br><b>Introduction:</b> Hub-and-spoke Center Model is initiated, in which peripheral dialysis centers (Spoke Centers) are monitored by Hub Center (Nodal Center). <b>Aim:</b> The aim of the study was to analyze the model of dialysis of Hub-and-Spoke dialysis in our tertiary care center. <b>Methods:</b> Data were collected over a period of 1 year in our center. Functioning of 12 spoke centers, clinicoepidemiological profile of dialysis patients was analyzed. <b>Results:</b> Monitoring the spoke centers included daily interaction with spoke center doctor, nurse, technician, patients through video calling, and guiding them in patient-related problems, infrastructure, reverse osmosis (RO) plant, and administrative issues. Monthly visit by nephrologist to spoke centers and providing outpatient department services to the dialysis patients and scrutinizing the patient data registers, RO plant inspection, water quality analysis data, etc., is being done. Among three hub centers, 30% of patients are being dialyzed in Gandhi Hub-and-Spoke model. Around 6770 sessions of dialysis are done per month for 687 patients registered, with 49% of patients receiving twice weekly hemodialysis. Nearly 25% of machines dedicated to hepatitis B surface antigen and hepatitis C virus-positive patients. Sixty-six patients still on waiting list and less technician staff (one technician/nine patients) indicates need for increasing the machines and staff to improve dialysis care at peripheral centers. <b>Conclusion:</b> Hub-and-Spoke model is an excellent model to provide quality dialysis support to patients in remote areas. Due to increase in dialysis patients, machines and staff need to be increased. Continuous surveillance of the model will help to develop measures/guidelines for effective functioning of the model.<br>