An analysis of a case manager-driven emergent dialysis program

Area of Science:

• Nephrology
• Healthcare Management
• Public Health

Background:

• Rising undocumented immigrant population in the US leads to increased end-stage renal disease (ESRD) patients lacking regular dialysis access.
• Hospital systems face challenges in providing care for this vulnerable ESRD population.
• Existing care models for undocumented ESRD patients without consistent dialysis access require evaluation.

Purpose of the Study:

• To assess the feasibility, effectiveness, and cost-efficiency of a case manager-driven emergent dialysis program.
• To compare this emergent dialysis model with the institution's previous regularly scheduled dialysis program.
• To determine if the emergent model could provide comparable or improved outcomes at a similar or lower cost.

Main Methods:

• A before-and-after study design was employed at Wishard Memorial Hospital, an urban public hospital.
• A cohort of 6 dialysis patients without regular dialysis access was analyzed.
• Secondary data from March 11, 2010, to September 14, 2010, were used to compare the emergent program with the prior scheduled dialysis approach.

Main Results:

• The case manager-driven emergent dialysis program was found to be feasible.
• Total expenses for the emergent program were $101,802, compared to $122,890 for the previous regular dialysis program.
• No significant differences were observed in intensive care unit days, length of stay, or complications between the two care models during the study period.

Conclusions:

• Case management is crucial for high-risk ESRD patients lacking consistent dialysis access.
• The emergent dialysis model, with case management oversight, demonstrated comparable or better cost-effectiveness than chronic, scheduled dialysis.
• While not definitively proving superiority over chronic dialysis, the study highlights the significant role of case management in optimizing care for this population without increasing complications.