Abstract: FR-PO806
Effects of the Specific Oriented Care in Hemodialysis Incident Patients (SOCHIP) Program on Key Performance Indicators and Early Mortality
Session Information
- Dialysis: Hospitalization and Mortality
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Chazot, Charles, Fresenius Medical Care, Fresnes, France
- Stuard, Stefano, Fresenius Medical Care, Bad Homburg, Germany
Background
An increased risk of early mortality exists for patients (pts) starting chronic hemodialysis (HD) therapy. In the French NephroCare (NC) centers a Specific Oriented Care for HD Incident Patients (SOCHIP) program has been implemented.
Methods
The SOCHIP program started in October 2015. One nurse was in charge to recover monthly the Key Performance Indicators (KPIs) for all incident HD pts during the first 4 months. The prescriptions of pts out of target were reviewed monthly. We have retrospectively calculated monthly the % of pts in target before and after the implementation of the SOCHIP program.
Results
Respectively, 816 (SOCHIP-) and 666 (SOCHIP+) pts have been analyzed (age:68,4 and 68,7 yo; % females: 35 and 31,3; Charlson Index:5,1 and 5,2). At M4 the % of pts in target has been significantly increased for effective treatment time (≥720 minutes/week; 33 versus 43%, p=0,0007), the processed blood volume (240 liters/week; 20,0 versus (vs) 43,8%, p<0,0001), KT/V (≥1.4; 37,5 vs 56,4%, p<0,0001) the HyS (<13% (females) and <15% (males); 38,7 vs 65,9%, p<0,0001), the hemodynamic status (BCM® + predialysis systolic blood pressure <160 mmHg; 53,2 vs 65,7%, p<0,0001), albuminemia (≥35g/l; 51,6 vs 59,4, p=0,094). There was no significant changes of the % of patients in target for the vascular access (AV fistula; 54,0 vs 49,2%), hepatitis-B protection (Ac antiHbs+ or complete immunization record in E5; 96,7 vs 98,0%), Hemoglobine (≥10g/dl ou between 10 et 12g/dl if EPO; 52,8 vs 54,8%) and mid-week phosphatemia (<1,65 mmoles/l or >0,75 mmoles/l if Pi-binders prescription; 67,9 vs 69,4%). The crude mortality has significantly decreased from 30,1 to 22,4 for 100 patient/years p=0.0002).
Conclusion
These data show that the SOCHIP program has allowed to improve the % of pts in target for 6 out of 10 usual KPIs.The KPIs improvement parallels the improvement of the early mortality. Other parameters included in the SOCHIP program have not been evaluated (early access to cardiologist and diabetologist). Moreover, the significant increase of pts in target for albuminemia suggests that the early access to the dietitian has been improved by the SOCHIP program.
We can conclude that a specific program for incident HD patient improves the % of pts in target of most of the KPIs and may improve the early mortality in this setting.