DaVita, the nation’s second largest dialysis chain, is spearheading efforts to improve CKD care.
The kidney-care community can point to more than 30 years of clinical accomplishments.
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In particular, the past 10 years have been marked by steady improvement in patient access to dialysis centers and improvement in clinical outcomes. Still, important challenges remain. The renal community must understand these challenges and continue the tradition of developing innovative programs to assist nephrologists in overcoming them in the future.
DaVita’s approach to shaping the future is to no longer be a “dialysis” company, but a kidney-care entity, dedicating resources to the full continuum of kidney disease and nephrology practice needs. It is worth highlighting a few of the programs which we believe are essential to meeting the future challenges of kidney care.
Focus on vascular access
Vascular access remains the “Achilles heel” of the dialysis patient, a leading cause of hospitalization and mortality when catheters and arteriovenous grafts predominate. Appropriate use of autologous arteriovenous fistulas (AVFs) should be demanded. This would result in fewer catheters and less morbidity from catheter-related complications.
AVFs and grafts, however, frequently malfunction, and the availability of dedicated outpatient vascular access centers that are organized as extensions of nephrology practices can dramatically improve outcomes, increase patient satisfaction with care, and lower costs. Salvage and reparative procedures previously performed in the hospital are now completed within a few hours in outpatient settings, avoiding unnecessary hospitalizations and missed dialysis treatments.
Organizations like DaVita Lifeline manage such centers and have partnered with nephrologists in this effort. As a result, patients are better off clinically, care is more convenient, practices generate additional income, payers save money over the long term, and nephrologists have better control over their work-life balance.
Medication management
Dialysis patients take six to 10 different medications per day. Keeping track of these meds for patients and caregivers is a nightmare, and constant trips to the pharmacy to fill prescriptions can be difficult. One innovative approach to this problem is the DaVita Rx program, which delivers medications to almost 7,000 patients at their dialysis facilities.
Such a facility-based program enables accurate tracking of current medications if linked to a facility/enterprise information system, and adds convenience for the patient. It minimizes the need to visit a pharmacy. This program saves time for nephrologists by offering an accurate, updated medication list and providing information on drug interactions that may adversely impact patient outcomes.
Emphasis on home dialysis
Considerable evidence shows that home dialysis may offer patients significant clinical and quality of life advantages. For many nephrologists, however, providing home dialysis has been difficult because of the lack of infrastructure to identify, train, and manage home patients. Development of home dialysis programs that are designed to provide the infrastructure support nephrologists need so that they can comfortably provide this important service would encourage greater use of this important modality.
Such support is designed so that the highest quality home dialysis care can be provided with state-of-the-art equipment. Many nephrologists are concerned that home care will place a burden on their staff and their own time, but carefully designed home dialysis programs can remove that burden. In addition, nephrologists who offer home dialysis training and follow-up care gain a competitive edge by broadening the dialysis services offered and being recognized as a nephrology practice leaders in the local kidney-care community.
