A case management model to improve hemodialysis outpatient outcomes

Optimal outpatient dialysis care is often difficult to achieve and a case management model to augment conventionally applied nursing and physician resources focusing on continuous quality improvement presents a possible solution to improving outcomes in this setting. We applied this model to patients followed by our physician group. Continuous quality improvement data generated from the dialysis unit database were used to analyze outcomes in patients enrolled in this model. Data from the cohort of patients followed in 2003 served as the reference source for comparative purposes. The nurse case manager assumed responsibility during the second quarter of 2004. Comparing outcomes data from 2005 with data from 2003, we were able to achieve a 3.12% improvement in the annualized mean percent crude mortality per 100 patient years (p<0.003). There was a 3.46-day trend to improvement in patient hospital days per year (p<0.06). The percentage of catheters used as primary access decreased by 9.59% (p<0.025), and the percentage of patients meeting an eKdrt/V goal > or =1.2 increased by 15.33% to 92.37% (p<0.001). These data appear to support the utility of a case manager model in our system.