Dialysis aids results for kidney disease patients
Dialysis aids results for kidney disease patients
Eight-bed unit is in rehab hospital
A partnership that adds a dialysis unit to a comprehensive rehabilitation facility is expected to shorten the length of stay for rehab patients with kidney diseases.
Great Lakes Rehabilitation Hospital in Southfield, MI, has teamed up with a division of Henry Ford Health Systems in Detroit to set up an eight-patient dialysis unit in the 101-bed rehab hospital. The dialysis unit opened in May.
Most of the dialysis patients who have been through the Great Lakes rehab program otherwise would have been admitted to a ursing home or sent home and transported for dialysis.
"These patients have not been able to get adequate rehab services to improve the quality of life," says Claude Oster, MD, president and chief executive officer.
In the past, many insurance companies often have opted to put rehab patients who need dialysis in a less costly setting, such as a nursing home, rather than in a rehab hospital, since the cost of transportation for dialysis is an additional expense, and the length of stay for dialysis patients typically has been lengthy.
"They are wasting money by paying for transportation and a longer length of stay when patients do not receive optimal care. With units such as ours, insurance companies can save on transportation cost and can save on a shorter length of stay," Oster says.
Logistical problems
When dialysis patients have been admitted to the rehab hospital, the staff has struggled with logistical problems involved in transporting patients to another location for dialysis. Then, when the patients return to the rehab facility, they often are too tired for therapy, so they effectively miss a day of rehab services, which lengthens their stay, Oster says. "If we are admitting patients primarily for rehab, we have to address that problem. By putting dialysis in-house, we can coordinate the dialysis and not interfere with the patient’s rehab services."
As a result, patients receive their full complement of rehab services each day, get proper meals and medication, and are not exhausted from a trip to another facility, he adds.
Kidney disease can cause other conditions that create the need for rehabilitation services, Oster says. For instance, patients with advanced stage renal disease develop vascular problems that sometimes lead to amputation. Kidney disease also exacerbates hypertension, leading to strokes.
Many of these patients are confined to nursing homes or subacute units where they get limited therapy, he says. "When you look at that patient population, you find that rehab services can improve their quality of life and function. But when they need dialysis, rehab can be provided effectively only in the kind of setting we are offering."
Primary diagnosis
Patients are admitted to the service that treats their primary diagnosis. For instance, stroke patients who need dialysis are treated like all other stroke patients, except they also receive dialysis.
"It’s not really a special program. We look at the rehab needs of patients based on their primary diagnosis. Dialysis is a life-sustaining process that must be done incidental to treating their rehab diagnosis," Oster says.
The rehab hospital set up a contract with the Greenfield Services division of Henry Ford to provide dialysis to its rehab patients. Greenfield provides the staff, equipment, quality assurance, and other components of the dialysis unit.
Greenfield staffs the dialysis unit based on patients census, and Great Lakes Rehab Hospital reimburses based on a contractual arrangement and includes the cost of dialysis in its bills to payers.
Although it is too soon for quantitative data, Oster expects the length of stay for the dialysis patients to be within the expected range for all patients with each primary diagnosis.
"Dialysis should not affect the length of stay. They should be able to receive rehab service within the same period of time as other patients with the same diagnosis," he says.
But for patients who have been unable to receive comprehensive rehab services, Oster anticipates much better outcome and a higher quality of life.
"In some other setting, patients could never get the full rehab services they need, or it will take much longer to reach the same level," he says.
The new program has been extremely well received, Oster says.
"The patients and families like it. It is less fatiguing and far more effective for the patient to receive dialysis in the rehab hospital, and it is less demanding on the family," he adds.
Oster plans to follow up with the Function Independence Measure (administered by the Uniform Data System for Medical Rehabilitation in Buffalo, NY) scores of the patients who receive the rehab hospital-based dialysis and compare them with previous patients who were transported off-campus for dialysis.
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