An integrated dialysis delivery network in Ontario

Area of Science:

• Nephrology
• Health Services Management

Background:

• The Ontario Ministry of Health (MOH) sought to expand dialysis services through a request for proposal (RFP).
• London Health Sciences Centre (LHSC) successfully expanded its network to include satellite dialysis units.

Purpose of the Study:

• To establish an operational model for new satellite dialysis services.
• To evaluate the clinical impact of integrated self-care and full-care dialysis models in community settings.

Main Methods:

• Development of an integrated dialysis delivery network with satellite locations.
• Implementation of a balanced scorecard evaluation model (Kaplan & Norton, 1992).
• Analysis of initial outcome data comparing self-care and full-care patients.

Main Results:

• Full-care patients in satellite units required more support from central London units.
• Full-care patients experienced more hypotensive episodes during dialysis.
• Some full-care patients exhibited lower dialysis adequacy and nutritional status compared to self-care patients.

Conclusions:

• Community-based dialysis models require careful consideration of patient type.
• Findings will inform revisions to patient inclusion criteria for optimizing satellite dialysis services.
• Further refinement of processes is needed to enhance the effectiveness of community dialysis care.