Renal rehabilitation and improved patient outcomes in Texas dialysis facilities☆☆☆★★★
Abstract
Background: Because a cure is not a reasonable goal for patients with end-stage renal disease (ESRD), optimal physical and mental health functioning are primary objectives of care and major determinants of health-related quality of life, morbidity, and mortality. This cross-sectional study used facility-level survey data to test the hypothesis that dialysis unit rehabilitation activities are associated with higher patient functional status. Methods: Data were collected from 169 dialysis facilities in the ESRD Network of Texas (Network 14), including facility characteristics, facility-level patient demographic and clinical characteristics, and facility rehabilitation activities measured by the Life Options Unit Self-Assessment Tool (USAT). Facility-level data on patient functioning and well-being measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were obtained from all 86 of the respondent facilities that collected it. Results: Most participating facilities reported performing rehabilitation activities in all five categories (encouragement, education, exercise, employment, and evaluation). The median number reported was 32 of a possible 100 activities. Exercise interventions were the least often implemented activities. Linear multiple regression showed that facility rehabilitation activity scores measured by the USAT were associated with higher facility mean Mental Component Scale (MCS) scores, controlling for facility characteristics (size, profit status), facility-level patient demographic characteristics (diabetes, race, sex, age), and facility-level patient laboratory variables: urea reduction ratio and hemoglobin and serum albumin levels. Conclusion: Because MCS scores have been shown in other studies to be inversely related to morbidity and mortality, this finding suggests that the introduction of rehabilitation interventions into the dialysis care regimen may prove beneficial. © 2002 by the National Kidney Foundation, Inc.
Keywords: Rehabilitation, physical functioning, mental health functioning, Mental Component Scale (MCS), morbidity, mortality
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☆ This research was conducted by the Life Options Rehabilitation Program, administered by the Medical Education Institute, and supported in part by an educational grant from Amgen Renal Advances and grant no. K24 DK02856 from The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (M.J.K.).
☆☆ The analyses upon which this publication is based were performed under contract no. 500-00-NW14 entitled End-Stage Renal Disease Networks Organization for the State of Texas sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore require no special funding on the part of this contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.
★ Address reprint requests to Roberta Braun Curtin, PhD, Medical Education Institute, Inc, Life Options Rehabilitation Program, Research Director, 414 D'Onofrio Dr, Ste 200, Madison, WI 53719. E-mail: rbcurtin@worldnet.att.net
★★ 0272-6386/02/4002-0014$35.00/0
PII: S0272-6386(02)00047-1
doi:10.1053/ajkd.2002.34517
© 2002 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
