Improving Outcome of Dialysis Patients in the Initiation Phase 公开
Jabi, Rania (Spring 2019)
Abstract
Abstract
Purpose:The purpose of this thesis was to refine general public health and practitioner knowledge regarding interventions that would improve dialysis patient outcomes including patient survival and quality of life. Patient morbidity and mortality could be reduced by systematically identifying measures that might improve dialysis outcomes. A systematic literature review would help reveal and evolve practices in this area.
Methods:This thesis utilized a systematic literature review with relevant articles and analyzed the data available to address the question of how to improve outcome of dialysis patients in the first year of dialysis treatment. The first year of dialysis is usually associated with high mortality, morbidity and healthcare cost. The systematic literature review produced ten peer reviewed studies for analysis. The common outcome variables in all studies were identified and compared.
Results:All of the selected studies contained important conclusions regarding the importance of vascular access type, arteriovenous fistula (AVF) and its benefits to improve patient outcome. Improving vascular access for incident hemodialysis patients was very important. This could be achieved by increasing the percentage of hemodialysis patients who use AVF as the primary mode of vascular access at the start of treatment.
Conclusions:Public Health and practitioner education is needed to increase the knowledge regarding the benefits of early referral of patients with advanced chronic kidney disease to nephrologist. This was also essential to improve outcome by providing better dialysis preparation and early placement of AVF. Providing structured programs for prompt educational and medical strategies in early end stage renal disease patients was promising and had potential benefits. Standardization of research data is needed as is additional research specifically including cost data.
Table of Contents
Table of Contents
Chapter 1: Introduction 1
Introduction and Rationale 1
Problem Statement 2
US Experience Poor 2
High U. S. Mortality Rates 4
Comparisons of Dialysis Methods & Outcomes Needed 5
Systematic Analysis Needed 7
Purpose Statement 9
Systematic Review 10
Significance Statement 11
Chapter 2: Review of literature 13
Introduction 13
Body of Review of Literature 13
Chronic Kidney Disease and end-stage renal disease 13
Importance of United States Renal Data System (USRDS) 14
Renal Replacement Options 15
Geographic Distribution in USA 15
Mortality 16
Vascular Access 17
Hospitalization 18
Health care cost 19
International Comparison 20
Summary of Current Problem and Study Relevance 21
Chapter 3: Methodology 24
Introduction 24
Literature Search Methodology 25
Eligibility Criteria 26
Inclusion/Exclusion Criteria 26
Data Extraction and quality assurance 28
Analysis Review 30
Chapter 4: Results 31
Introduction 31
Study Characteristics 31
Tables/figures that support analysis 32
Analysis of major themes and findings 34
Variables that were common to the studies 34
Variables that were missing from the studies 38
Results Summary 39
Chapter 5: Discussion 41
Introduction 41
Summary of key study findings 41
Limitations 41
Implications 42
Implications for General Public Health and Practitioner Practice 42
Implications for public health practice 42
Recommendations 43
General Public Health Education 43
Clinician Education 43
Patient Education 44
Enhancements to informatics (Electronic Health Records) 44
Recommendations for clinical practice 46
Recommendations for future research 48
Conclusion 48
References 50
About this Master's Thesis
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