An analysis of a case manager-driven emergent dialysis program

Christopher Weaver, Isaac J. Myers, Gretchen Huffman, Rancia Vohito, Dorian Herceg

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose of The Study: With the undocumented immigrant population in the United States on the rise, an increase in the number of patients with end-stage renal disease without access to a regular dialysis chair continues. This leaves hospital systems with the difficult decision of how best to care for this population. We sought to evaluate the feasibility, effectiveness, and costs of a case manager-driven emergent dialysis program. We hypothesized that this program would be feasible and would result in similar costs as the previous regularly scheduled dialysis program in place at our institution. Primary Practice Setting: The study was conducted at Wishard Memorial Hospital, which is an urban public hospital in Indianapolis, IN. Methodology and Sample: We performed a before (March 11, 2010, to June 11, 2010) and after (June 14, 2010, to September 14, 2010) study to compare the treatment of a 6-patient cohort of dialysis patients without a "dialysis home" before and after the case manager-driven emergent dialysis program, using secondary data. Results: The case manager-driven emergent dialysis process was feasible and led to a total expense of $101,802 as compared with a total cost of $122,890 when providing regular dialysis to this subset of patients. There were no differences in intensive care unit days, length of stay, and complications between the 2 groups in the short study period. Implications For Case Management Practice: The dialysis population without a "dialysis home" is a high-risk population in need of intensive medical care but the approach to these patients continues to be debated. Although this study does not prove or necessarily support a dialysis on "emergent" basis approach over chronic, scheduled dialysis, the study does demonstrate that case management can play a significant role in the care of these patients. Case management oversight and management of our patient population resulted in costs equal to, or better than, those who received chronic dialysis care without a difference in complications over a 6-month study period.

Original languageEnglish (US)
Pages (from-to)24-28
Number of pages5
JournalProfessional Case Management
Volume17
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

Fingerprint

Dialysis
Case Management
Population
Costs and Cost Analysis
Case Managers
Public Hospitals
Urban Hospitals
Critical Care
Chronic Kidney Failure
Cost-Benefit Analysis
Intensive Care Units
Length of Stay
Patient Care

Keywords

  • case management
  • cost
  • dialysis
  • end-stage renal disease
  • undocumented immigrant

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Leadership and Management

Cite this

An analysis of a case manager-driven emergent dialysis program. / Weaver, Christopher; Myers, Isaac J.; Huffman, Gretchen; Vohito, Rancia; Herceg, Dorian.

In: Professional Case Management, Vol. 17, No. 1, 01.2012, p. 24-28.

Research output: Contribution to journalArticle

Weaver, Christopher ; Myers, Isaac J. ; Huffman, Gretchen ; Vohito, Rancia ; Herceg, Dorian. / An analysis of a case manager-driven emergent dialysis program. In: Professional Case Management. 2012 ; Vol. 17, No. 1. pp. 24-28.
@article{9568a639df374375a36a8646a03a761e,
title = "An analysis of a case manager-driven emergent dialysis program",
abstract = "Purpose of The Study: With the undocumented immigrant population in the United States on the rise, an increase in the number of patients with end-stage renal disease without access to a regular dialysis chair continues. This leaves hospital systems with the difficult decision of how best to care for this population. We sought to evaluate the feasibility, effectiveness, and costs of a case manager-driven emergent dialysis program. We hypothesized that this program would be feasible and would result in similar costs as the previous regularly scheduled dialysis program in place at our institution. Primary Practice Setting: The study was conducted at Wishard Memorial Hospital, which is an urban public hospital in Indianapolis, IN. Methodology and Sample: We performed a before (March 11, 2010, to June 11, 2010) and after (June 14, 2010, to September 14, 2010) study to compare the treatment of a 6-patient cohort of dialysis patients without a {"}dialysis home{"} before and after the case manager-driven emergent dialysis program, using secondary data. Results: The case manager-driven emergent dialysis process was feasible and led to a total expense of $101,802 as compared with a total cost of $122,890 when providing regular dialysis to this subset of patients. There were no differences in intensive care unit days, length of stay, and complications between the 2 groups in the short study period. Implications For Case Management Practice: The dialysis population without a {"}dialysis home{"} is a high-risk population in need of intensive medical care but the approach to these patients continues to be debated. Although this study does not prove or necessarily support a dialysis on {"}emergent{"} basis approach over chronic, scheduled dialysis, the study does demonstrate that case management can play a significant role in the care of these patients. Case management oversight and management of our patient population resulted in costs equal to, or better than, those who received chronic dialysis care without a difference in complications over a 6-month study period.",
keywords = "case management, cost, dialysis, end-stage renal disease, undocumented immigrant",
author = "Christopher Weaver and Myers, {Isaac J.} and Gretchen Huffman and Rancia Vohito and Dorian Herceg",
year = "2012",
month = "1",
doi = "10.1097/NCM.0b013e31822f6042",
language = "English (US)",
volume = "17",
pages = "24--28",
journal = "Professional Case Management",
issn = "1932-8087",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - An analysis of a case manager-driven emergent dialysis program

AU - Weaver, Christopher

AU - Myers, Isaac J.

AU - Huffman, Gretchen

AU - Vohito, Rancia

AU - Herceg, Dorian

PY - 2012/1

Y1 - 2012/1

N2 - Purpose of The Study: With the undocumented immigrant population in the United States on the rise, an increase in the number of patients with end-stage renal disease without access to a regular dialysis chair continues. This leaves hospital systems with the difficult decision of how best to care for this population. We sought to evaluate the feasibility, effectiveness, and costs of a case manager-driven emergent dialysis program. We hypothesized that this program would be feasible and would result in similar costs as the previous regularly scheduled dialysis program in place at our institution. Primary Practice Setting: The study was conducted at Wishard Memorial Hospital, which is an urban public hospital in Indianapolis, IN. Methodology and Sample: We performed a before (March 11, 2010, to June 11, 2010) and after (June 14, 2010, to September 14, 2010) study to compare the treatment of a 6-patient cohort of dialysis patients without a "dialysis home" before and after the case manager-driven emergent dialysis program, using secondary data. Results: The case manager-driven emergent dialysis process was feasible and led to a total expense of $101,802 as compared with a total cost of $122,890 when providing regular dialysis to this subset of patients. There were no differences in intensive care unit days, length of stay, and complications between the 2 groups in the short study period. Implications For Case Management Practice: The dialysis population without a "dialysis home" is a high-risk population in need of intensive medical care but the approach to these patients continues to be debated. Although this study does not prove or necessarily support a dialysis on "emergent" basis approach over chronic, scheduled dialysis, the study does demonstrate that case management can play a significant role in the care of these patients. Case management oversight and management of our patient population resulted in costs equal to, or better than, those who received chronic dialysis care without a difference in complications over a 6-month study period.

AB - Purpose of The Study: With the undocumented immigrant population in the United States on the rise, an increase in the number of patients with end-stage renal disease without access to a regular dialysis chair continues. This leaves hospital systems with the difficult decision of how best to care for this population. We sought to evaluate the feasibility, effectiveness, and costs of a case manager-driven emergent dialysis program. We hypothesized that this program would be feasible and would result in similar costs as the previous regularly scheduled dialysis program in place at our institution. Primary Practice Setting: The study was conducted at Wishard Memorial Hospital, which is an urban public hospital in Indianapolis, IN. Methodology and Sample: We performed a before (March 11, 2010, to June 11, 2010) and after (June 14, 2010, to September 14, 2010) study to compare the treatment of a 6-patient cohort of dialysis patients without a "dialysis home" before and after the case manager-driven emergent dialysis program, using secondary data. Results: The case manager-driven emergent dialysis process was feasible and led to a total expense of $101,802 as compared with a total cost of $122,890 when providing regular dialysis to this subset of patients. There were no differences in intensive care unit days, length of stay, and complications between the 2 groups in the short study period. Implications For Case Management Practice: The dialysis population without a "dialysis home" is a high-risk population in need of intensive medical care but the approach to these patients continues to be debated. Although this study does not prove or necessarily support a dialysis on "emergent" basis approach over chronic, scheduled dialysis, the study does demonstrate that case management can play a significant role in the care of these patients. Case management oversight and management of our patient population resulted in costs equal to, or better than, those who received chronic dialysis care without a difference in complications over a 6-month study period.

KW - case management

KW - cost

KW - dialysis

KW - end-stage renal disease

KW - undocumented immigrant

UR - http://www.scopus.com/inward/record.url?scp=83155190187&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=83155190187&partnerID=8YFLogxK

U2 - 10.1097/NCM.0b013e31822f6042

DO - 10.1097/NCM.0b013e31822f6042

M3 - Article

VL - 17

SP - 24

EP - 28

JO - Professional Case Management

JF - Professional Case Management

SN - 1932-8087

IS - 1

ER -