Improving Patient-Centered Care for End-Stage Renal Disease Patients at a Community Palliative Setting.

Abstract

End-stage renal disease (ESRD) is a complex medical condition growing fastest in Americans 65 years and older. Despite its chronic nature, fewer than 10% of these patients have had advanced care planning. A chart audit (n = 20) of the palliative patients at a community palliative program revealed that no patient had a conversation about prognostication, 10% (n = 2) about the burden of kidney disease, 30% (n = 6) had coordination of care with the nephrologist, and 35% (n = 7) had engaged in end-of-life planning. This project aimed to increase patient-centered care for ESRD patients to 80% in 90 days. The project utilized the Plan-Do-Study-Act quality improvement model in four 2-week rapid cycles with 2 focus improvement areas. The 2 core interventions were patient screening for preferences and values and providing the right care for palliative management utilizing a checklist. At the end of the project, patient-centered right care for ESRD increased from a baseline of 24% to 94%. Patient engagement scores increased from a baseline of 3.2 to 4.9 on a 5-point Likert scale, with 5 being the highest supporting a shared decision model of care in improving patient-centered right care.