Kidney Week

Abstract: FR-PO966

Ambulatory Palliative Care (PC) in Advanced CKD

Session Information

• CKD Interventions: Trials and Quality Improvement
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Ravipati, Prasanti S., Tufts Medical Center, Boston, Massachusetts, United States

Prasanti S. Ravipati,

• Buss, Mary Kathleen, Tufts Medical Center, Boston, Massachusetts, United States

Mary Kathleen Buss,

• Gilbert, Scott J., Tufts Medical Center, Boston, Massachusetts, United States

Scott J. Gilbert,

Background

Under 10% of patients on dialysis discuss goals, values, and preferences with their nephrologist; nearly 90% want to. PC can enhance patient quality of life, improve illness understanding and alter decisions at end of life. Global ambulatory renal PC clinics have been successful but are rare in the US.

We tested the feasibility of integrating ambulatory PC for patients with CKD via manual EMR screening.

Methods

Renal and PC developed screening criteria:
1. Age >70 w/ stage 5 CKD
2. Age >70 w/ stage 4 CKD and cardiovascular disease or diabetes
3. Age >80 w/ stage 4 CKD

For 11 weeks, study staff used the EMR to screen patients scheduled in renal clinic. A list of patients who met criteria were emailed to renal providers. If deemed appropriate, renal introduced PC to the patient. If the patient agreed, a PC referral was placed. PC saw referred patients before or after their renal clinic visit in the same room.

Results

See Fig 1. Renal agreed 33% of patients who met criteria were PC appropriate. Of patients who met criteria, 19% were seen by PC (Fig 2). PC saw significantly more patients in the 3 months after the intervention (n= 22), compared to before the intervention (n = 3), [X² = 14.3; p <0.001].

Conclusion

Our study showed the feasibility of using screening criteria to integrate PC into renal clinic for advanced CKD patients. The higher volume seen by PC suggests the process helped renal providers identify patients appropriate for PC. Manual screening was resource intensive. An automated EMR screen would be more sustainable.

The continued increase in PC visits after the study suggests a change in practice and improved access to PC. Our model for an integrated renal PC clinic promotes patient centered quality care for patients with advanced CKD.