Abstract: TH-PO300
Improving Treatment Adherence in Patients on In-Center Hemodialysis through Daily Targeted Reporting and Intervention
Session Information
- Hemodialysis and Frequent Dialysis - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Chaudhuri, Sheetal, Fresenius Medical Care AG, Bad Homburg, Hessen, Germany
- Willetts, Joanna, Fresenius Medical Care AG, Bad Homburg, Hessen, Germany
- Halliday, Trevor, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Hosey, Melissa, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Usvyat, Len A., Fresenius Medical Care AG, Bad Homburg, Hessen, Germany
- Maddux, Franklin W., Fresenius Medical Care AG, Bad Homburg, Hessen, Germany
Background
In-center hemodialysis (ICHD) patients who miss prescribed treatments have an increased risk of hospitalization and mortality. We implemented daily targeted reporting (DTR) to identify patients who missed their scheduled treatment the day prior, followed by a tailored intervention to reschedule these missed treatments. Our goal is to describe treatment adherence before and after implementation of DTR and intervention.
Methods
We analyzed clinical data from ICHD patients in the periods before and after introduction of DTR across 16 clinics from a large dialysis organization. Targeted reporting of missed treatments began on 01Mar2024. Missed and ordered treatments, documented in patients' electronic health records, were summarized in the two months before (01Jan2024-29Feb2024) and after (01Mar2024-30Apr2024) initiation of DTR. DTR provided clinic staff with a list of patients who were absent during the scheduled treatment the previous day, enabling staff to reschedule treatments accordingly. Missed treatments were reported as a percent of ordered treatments and as a crude rate per patient per year (ppy). We used Analysis of Variance to test the difference in crude missed treatment rate (ppy) before and after implementation of DTR and intervention.
Results
There were 745 ICHD patients before and 722 ICHD patients after the DTR in the 16 clinics in this analysis. Demographic information for patients before and after DTR showed no significant differences. The percent of documented missed treatments decreased by nearly 6% following introduction of DTR. Crude rate ratio was 0.96 (95% confidence interval 0.80, 1.15) (Table 1).
Conclusion
Although not statistically significant, implementation of DTR suggests a reduction in missed treatments and improvement in treatment adherence in the short term. Future work includes monitoring missed treatments in these clinics to determine if DTR provides sustained reduction in missed treatment rate. Furthermore, conducting a matched analysis could offer insights into the magnitude of the effect.
Percent of missed treatments and missed treatment rate (ppy) before and after daily targeted reporting/intervention.
| Before (95% CI) | After (95% CI) | % Change | Rate Ratio (95% CI) | P-value | |
| % Missed Treatments | 5.34 | 5.02 | -5.99% | ||
| Crude Missed Treatment Rate (ppy, 95% CI) | 8.06 (7.12, 9.13) | 7.73 (6.79, 8.82) | -4.09% | 0.96 (0.80, 1.15) | 0.6497 |
Funding
- Commercial Support – Fresenius Medical Care