Abstract: SA-PO671

Predictors of Care Gaps in the Home Dialysis Virtual Ward

Session Information

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
  • Chan, Christopher T., Toronto General Hospital , Toronto, Ontario, Canada
  • Tennankore, Karthik K., Dalhousie/Nova Scotia Health, Halifax, Nova Scotia, Canada
  • Bargman, Joanne M., Toronto General Hospital , Toronto, Ontario, Canada
  • Copland, Michael A., University of British Columbia, Vancouver, British Columbia, Canada
  • Zimmerman, Deborah Lynn, The Ottawa Hospital, Ottawa, Ontario, Canada
  • Oliver, Matthew J., Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
  • Shah, Nikhil A., University of Alberta, Edmonton, Alberta, Canada
  • Finkle, Simon Neil, Dalhousie University, Hammonds Plains, Nova Scotia, Canada
  • Pauly, Robert P., University of Alberta, Edmonton, Alberta, Canada
Background

Despite the benefits of home dialysis, home dialysis patients are prone to medical complications, especially at time of a transition/change in care. The home dialysis virtual ward (HDVW) initiative aimed to describe gaps in care following these transition periods.

Methods

The HDVW is a multicenter Canadian study conducted between January 2014 and December 2015. Patients admitted to the HDVW experienced a transition event defined as one of: (1) transition from peritoneal dialysis (PD) or home hemodialysis (HHD) training to autonomous home dialysis (2) a discharge from hospitalization, (3) receipt of a medical/radiological procedure and (4) treatment with antibiotics. HDVW admission consisted of a maximum of 14 days of follow-up using repeated clinician-led telephone interviews. Gaps of care were identified when a change of management was required in any of these 3 domains: dialysis prescription, medication and follow-up care. Predictors of the care gaps were assessed in an adjusted ordinal logistic regression.

Results

Ninety HHD and 103 PD patients were included. Overall, 245 care gaps were identified in 135 patients. (Figure 1) Higher age > 65 years (odds ratio [OR] 2.92, 95% confidence interval [CI] 1.15-7.42, p=0.02) and female (OR 1.73, 95% CI 1.18-2.52, p=0.005) were associated with an increased risk in care gaps while medical procedure as a cause for HDVW admission (OR 0.22, 95% CI 0.09-0.54, p=0.001) or antibiotic-treatment (OR 0.35, 95% CI 0.14-0.87, p=0.03) had lower risk of care gaps compared to post hospital discharge HDVW admissions.

Conclusion

Gaps in care are frequent in the home dialysis population particularly following hospital discharge. Efforts should be directed toward improvement of transitional care especially among older individuals.