Comprehensive and Personalized Care of the Hemodialysis Patient in Tassin, France: A Model for the Patient-Centered Medical Home for Subspecialty Patients
The Centre de Rein Artificiel in Tassin, France, provides comprehensive care to patients with chronic renal disease similar to the model proposed for Patient Center Medical Homes; patients with end-stage renal disease in the Tassin Hemodialysis Center appear to have better outcomes than patients in the United States. These differences likely reflect this center’s approach to patient-centered care, the use of longer dialysis times, and focused vascular access care. Longer dialysis times provide better clearance of small and middle toxic molecules, salt, and water; 85% of patients at the Tassin center have a normal blood pressure without the use of antihypertensive medications. The observed mortality rate in patients at the Tassin Center is approximately 50% of that predicted based on the United States Renal Data system standard mortality tables. Patient outcomes at the Tassin center suggest that longer dialysis times and the use of multidiscipline teams led by nephrologists directing all health care needs probably explain the outcomes in these patients. These approaches can be imported into the U.S healthcare system and form the framework for patient-centered medical practice for ESRD patients. 1. Introduction End-stage renal disease (ESRD) continues to increase in prevalence and incidence in developed countries. This has challenged health care systems to distribute resources in ways that control expenditures and achieve the best possible outcomes. The International Study of Health Care Organization and Financing (ISHCOF) compared 12 developed countries with different health care economic policies and assessed incentives, benefits, and outcomes. The United States had the second highest death rate per year among patients on hemodialysis (HD) in this study, even though it had the highest annual expenditure per ESRD patient and per capita among those 12 countries [1]. In addition, there is significant dissatisfaction among both patients and physicians with the current health care system in this country [2, 3]. In the 2011 Commonwealth Fund Survey, more than 7 out of 10 adults in the United States felt the need for major changes in the health care system [3]. They listed difficult care access, poor care coordination, excessive costs, and the administrative hassle of health insurance as their main reasons and favored more patient-centered policies [3]. Because of the increasing need for change, the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Osteopathic Association have built
References
[1]
A. Dor, M. V. Pauly, M. A. Eichleay, and P. J. Held, “End-stage renal disease and economic incentives: the International Study of Health Care Organization and Financing (ISHCOF),” International Journal of Health Care Finance and Economics, vol. 7, no. 2-3, pp. 73–111, 2007.
[2]
T. Bodenheimer, “Primary care—will it survive?” The New England Journal of Medicine, vol. 355, no. 9, pp. 861–864, 2006.
[3]
K. Stremikis, C. Schoen, and A. K. Fryer, “A call for change: the 2011 Commonwealth Fund Survey of public views of the U.S. health system,” Issue Brief (Commonwealth Fund), vol. 6, pp. 1–23, 2011.
[4]
“American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA),” 2007, Joint Principles of the Patient-Centered Medical Home http://www.aafp.org/pcmh/principles.pdf.
[5]
D. R. Rittenhouse and S. M. Shortell, “The patient-centered medical home: will it stand the test of health reform?” Journal of the American Medical Association, vol. 301, no. 19, pp. 2038–2040, 2009.
[6]
T. D. DuBose Jr., M. T. Behrens, A. Berns, C. Davis, S. Goldfarb, T. Hostetter, et al., “The patient-centered medical home and nephrology,” Journal of the American Society of Nephrology, vol. 20, pp. 681–682, 2009.
[7]
E. Lacson Jr., W. Wang, J. M. Lazarus, and R. M. Hakim, “Hemodialysis facility-based quality-of-care indicators and facility-specific patient outcomes,” American Journal of Kidney Diseases, vol. 54, no. 3, pp. 490–497, 2009.
[8]
F. K. Port, R. L. Pisoni, J. L. Bragg-Gresham et al., “DOPPS estimates of patient life years attributable to modifiable hemodialysis practices in the United States,” Blood Purification, vol. 22, no. 1, pp. 175–180, 2004.
[9]
M. V. Rocco, D. L. Frankenfield, S. D. Hopson, and W. M. McClellan, “Relationship between clinical performance measures and outcomes among patients receiving long-term hemodialysis,” Annals of Internal Medicine, vol. 145, no. 7, pp. 512–519, 2006.
[10]
L. C. Plantinga, N. E. Fink, B. G. Jaar et al., “Attainment of clinical performance targets and improvement in clinical outcomes and resource use in hemodialysis care: a prospective cohort study,” BMC Health Services Research, vol. 7, article 5, 2007.
[11]
F. Tentori, W. C. Hunt, M. Rohrscheib et al., “Which targets in clinical practice guidelines are associated with improved survival in a large dialysis organization?” Journal of the American Society of Nephrology, vol. 18, no. 8, pp. 2377–2384, 2007.
[12]
G. Laurent and B. Charra, “The results of an 8 h thrice weekly haemodialysis schedule,” Nephrology Dialysis Transplantation, vol. 13, Supplement 6, pp. 125–131, 1998.
[13]
S. Barber, D. R. Appleton, and D. N. S. Kerr, “Adequate dialysis,” Nephron, vol. 14, no. 2, pp. 209–227, 1975.
[14]
E. Lacson Jr. and M. Lazarus, “Dialysis time: does it matter? A reappraisal of existing literature,” Current Opinion in Nephrology and Hypertension, vol. 20, no. 2, pp. 189–194, 2011.
[15]
K. S. Katzarski, B. Charra, A. J. Luik et al., “Fluid state and blood pressure control in patients treated with long and short haemodialysis,” Nephrology Dialysis Transplantation, vol. 14, no. 2, pp. 369–375, 1999.
[16]
J. E. Flythe, S. E. Kimmel, and S. M. Brunelli, “Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality,” Kidney International, vol. 79, no. 2, pp. 250–257, 2011.
[17]
B. Charra and C. Chazot, “Volume control, blood pressure and cardiovascular function: lessons from hemodialysis treatment,” Nephron Physiology, vol. 93, no. 4, pp. 94–101, 2003.
[18]
H. I. Feldman, S. Kobrin, and A. Wasserstein, “Hemodialysis vascular access morbidity,” Journal of the American Society of Nephrology, vol. 7, no. 4, pp. 523–535, 1996.
[19]
H. I. Feldman, P. J. Held, J. T. Hutchinson, E. Stoiber, M. F. Hartigan, and J. A. Berlin, “Hemodialysis vascular access morbidity in the United States,” Kidney International, vol. 43, no. 5, pp. 1091–1096, 1993.
[20]
G. Laurent, “How to keep the dialysis patients normotensive? What is the secret of Tassin?” Nephrology Dialysis Transplantation, vol. 12, no. 6, article 1104, 1997.
[21]
B. Charra, G. Jean, C. Chazot et al., “Intensive dialysis and blood pressure control: a review,” Hemodialysis International, vol. 8, no. 1, pp. 51–60, 2004.
[22]
R. A. Sherman, A. Daniel, and R. P. Cody, “The effect of interdialytic weight gain on predialysis blood pressure,” Artificial Organs, vol. 17, no. 9, pp. 770–774, 1993.
[23]
C. Bernard, C. Chazot, J. Guillaume, et al., “Long 3X 8 hr dialysis: the Tassin experience,” Nephrology Dialysis Transplantation, vol. 10, pp. 141–146, 2006.
[24]
G. A. Block, T. E. Hulbert-Shearon, N. W. Levin, and F. K. Port, “Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study,” American Journal of Kidney Diseases, vol. 31, no. 4, pp. 607–617, 1998.
[25]
E. G. Lowrie, M. Teng, E. Lacson, N. Lew, J. M. Lazarus, and W. F. Owen, “Association between prevalent care process measures and facility-specific mortality rates,” Kidney International, vol. 60, no. 5, pp. 1917–1929, 2001.
[26]
National Kidney Foundation, “KDOQI clinical practice guidelines and clinical practice recommendations for 2006 updates: hemodialysis adequacy, peritoneal dialysis adequacy and vascular access,” American Journal of Kidney Diseases, vol. 48, pp. S1–S322, 2006.
[27]
C. Chazot, “Can the hemodialysis strategy influence the nutritional status of hemodialysis patients?” Nephrologie et Therapeutique, vol. 5, no. 5, pp. S330–S333, 2009.
[28]
J. D. Kopple, T. Greene, W. C. Chumlea et al., “Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study,” Kidney International, vol. 57, no. 4, pp. 1688–1703, 2000.
[29]
C. Chazot, C. Vo-Van, C. Blanc et al., “Stability of nutritional parameters during a 5-year follow-up in patients treated with sequential long-hour hemodialysis,” Hemodialysis International, vol. 10, no. 4, pp. 389–393, 2006.
[30]
A. J. Collins, R. N. Foley, D. T. Gilbertson, and S. Chen, “The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis,” Clinical Journal of the American Society of Nephrology, vol. 4, no. 1, pp. S5–S11, 2009.
[31]
A. Innes, B. Charra, R. P. Burden, A. G. Morgan, and G. Laurent, “The effect of long, slow haemodialysis on patient survival,” Nephrology Dialysis Transplantation, vol. 14, no. 4, pp. 919–922, 1999.
[32]
R. L. Wingard, L. B. Pupim, M. Krishnan, A. Shintani, T. A. Ikizler, and R. M. Hakim, “Early intervention improves mortality and hospitalization rates in incident hemodialysis patients: rightstart Program,” Clinical Journal of the American Society of Nephrology, vol. 2, no. 6, pp. 1170–1175, 2007.
[33]
S. M. Wilson, J. A. Robertson, G. Chen, P. Goel, D. A. Benner, M. Krishnan, et al., “The IMPACT ( incident management of patients, actions centered on treatment) program: a quality improvement approach foe caring for patients initating long-term dialysis,” American Journal of Kidney Diseases, vol. 60, pp. 435–443, 2012.
[34]
E. Lacson and F. W. Maddux, “Intensity of care and better outcomes among hemodialysis patients: a role for the medical director,” Seminars in Dialysis, vol. 25, pp. 284–302, 2012.
[35]
R. Vanholder, A. Davenport, T. Hannedouche, J. Kooman, A. Kribben, N. Lameire, et al., “Reimbursement of dialysis: a comparison of seven countries,” Journal of the American Society of Nephrology, vol. 23, pp. 1291–1298, 2012.
[36]
F. Tentori, J. Zhang, Y. Li et al., “Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS),” Nephrology Dialysis Transplantation, vol. 27, pp. 4180–4188, 2012.
[37]
B. M. Robinson, D. S. Fuller, B. A. Bieber, M. N. Turenne, and R. L. Pisoni, “The DOPPS practice monitor for U.S. dialysis care: trends through April 2011,” American Journal of Kidney Diseases, vol. 59, pp. 309–314, 2012.
[38]
P. G. Kerr, “International differences in hemodialysis delivery and their influence on outcomes,” American Journal of Kidney Diseases, vol. 58, pp. 461–470, 2011.
