Development of a patient classification system for chronic hemodialysis patients

The purpose of this project was to develop a patient classification system that could indicate the caregiver time required by chronic hemodialysis patients during one dialysis treatment session. A patient acuity tool that used a condition indicator model was developed and validated. Initial indicator weights were established by an expert panel of 12 center directors. An experimental design was formulated that permitted evaluation of the influence of independent factors, such as type of ownership and cost-per-treatment environment on the acuity-time relationship. Acuity-time data were collected on more than 600 individual treatments performed in 12 different centers across the country. Results indicate that patient acuity, measured by The American Nephrology Nurses' Association (ANNA)/MECON acuity tool, is a strong predictor of the caregiver time that will be required by the patient during that treatment session (P < 0.0001) and that centers differ in the amount of time that caregivers spend with patients who are rated at the same level of acuity (P = 0.001). The overall average time spent by caregivers ranged from 61 minutes per treatment for level I patients to 97 minutes per treatment for level 5 patients. Ownership and cost-per-treatment effects were not significant as independent factors. However, some combinations of ownership and cost-per-treatment data may be significant.