Fredric O. Finkelstein|Hima Yalamanchili|Alan S. Kliger
Patient Perceptions and Experiences of ESRD Care: Quality and Satisfaction
Yale New Haven Hospital|Yale New Haven Hospital|Yale New Haven Hospital
related articlep 440 related articlep 440 health care reform unfolds clear change focus health care delivery move patientcentered care approach1bardes md defining patientcentered medicinen engl j med 2012 366 782783crossref pubmed scopus 189 google scholar 2barry mj edgmanlevitan shared decision makingthe pinnacle patientcentered caren engl j med 2012 366 780781crossref pubmed scopus 2056 google scholar term used commonly meaning may always clear patientcentered care involves active participation patients family andor caregivers determine type nature standard care best suited maximize individuals quality life goal empower individual make informed decisions focus shifts insistence adherence compliance collaboration dialogue cooperation role health care provider shifts focusing providing patients tools knowledge make decisions guide treatment patient choice becomes important focus outcomesoutcomes matter patients thus nature character relationship patient provider changes understanding relationship becomes critically important patients comprehend complexities care actively participate decisions care surprising ways investigations undertaken understand nature relationship patients endstage renal disease esrd health providers3juergensen e wuerth finkelstein sh juergensen pj bekui finkelstein fo hemodialysis peritoneal dialysis patients assessment satisfaction therapy impact therapy livesclin j soc nephrol 2006 1 11911196crossref pubmed scopus 144 google scholar 4rubin hr fink ne plantinga lc sadler jh kliger powe nr patient ratings dialysis care peritoneal dialysis vs hemodialysisjama 2004 291 697703crossref pubmed scopus 245 google scholar thus article issue ajkd paddison et al addressing experiences care among 3794 medicare beneficiaries esrd particular interest5paddison cam elliott mn haviland et alexperiences care among medicare beneficiaries esrd medicare consumer assessment healthcare providers systems cahps survey resultsam j kidney dis 2013 61 440449abstract full text full text pdf pubmed scopus 46 google scholar note comparisons esrd patients approximately 820000 nonesrd medicare beneficiaries indicate esrd patients least satisfied overall care six composite outcomes 4 care domains access care doctor communication customer service access prescription drugs drug information 4 ratings overall care personal physician specialist physician prescription drug plan used examine patients experiences esrd patients reported better care experiences 7 10 measures nonesrd patients however adjusted mean differences less 3 points 0100 scale observations encouraging terms care provided esrd patients findings deserve special attention examples note include lesspositive experiences reported blacks compared whites patients low educational levels compared higher educational levels differences small clearly present reasons differences obvious certainly warrant study also hispanic patients reported greater satisfaction several domains compared whites suggests relationship racial ethnic background satisfaction may complex lower scores terms educational levels seen patients 8thgrade level education interest relationship educational background satisfaction hold consistently general medicare population however hold patients chronic diseases diabetes5paddison cam elliott mn haviland et alexperiences care among medicare beneficiaries esrd medicare consumer assessment healthcare providers systems cahps survey resultsam j kidney dis 2013 61 440449abstract full text full text pdf pubmed scopus 46 google scholar whether reflects problems literacy ability understand complex medical conditions esrd needs studied issues involving patient satisfaction care important address health care moves patientcentered model however paddison study leaves important questions unanswered perhaps importantly relationship patient satisfaction care actual safety efficacy standards quality care delivered goal health providers deliver best care manner results patient comfort safety satisfaction satisfaction end itselfit must viewed context quality care delivered example drugs efficiently delivered low cost patients wrong drugs prescribed patients might satisfied experience perhaps worse outcomes similarly proper drugs prescribed patients unable obtain logistic constraints unwilling take poor understanding importance taking drugs care undermined thus developing instruments strategies integrate assessment quality efficacy safety care patient satisfaction need explored esrd patients second questionnaire ask right questions concerns esrd patients may different nondialysis population generic instrument measure patient experience may capture priorities assess satisfaction care actually talking esrd patients individually andor focus groups order better understand issues important define arenas patients would like focus would appropriate patientcentered world third differences noted esrd nonesrd patients study differences statistically significant clinically meaningful difficult know small statistically significant differences reported patients using standardized instruments meaningful patients problem created dilemmas investigators patientreported outcomes used frequently validated outcome measures clinical trials5paddison cam elliott mn haviland et alexperiences care among medicare beneficiaries esrd medicare consumer assessment healthcare providers systems cahps survey resultsam j kidney dis 2013 61 440449abstract full text full text pdf pubmed scopus 46 google scholar 6wu aw fink ne cagney ka et aldeveloping healthrelated qualityoflife measure endstage renal disease choice health experience questionnaiream j kidney dis 2001 37 1121abstract full text full text pdf pubmed google scholar 7hayes rd wooley jm concept clinically meaningful difference healthrelated quality life researchpharmacoeconomics 2000 18 419crossref pubmed scopus 386 google scholar 8samsa g edelman rothman ml et aldetermining clinically important differences health status measures general approach illustration health utilities index mark iipharmacoeconomics 1999 15 141155crossref pubmed scopus 717 google scholar final consideration whether truly multidisciplinary approach health care esrd care patients really separate contribution nephrologist rest patient care team model health care delivery esrd patient different provided primary physician freestanding office clinic care dependent relationship physician patient relationships esrd patient health care providers may complex hemodialysis patients generally see health care team 3 times week see nephrologist 1 4 times per month dialysis facility peritoneal dialysis patients generally see multidisciplinary team including nephrologist month clinic environment patient may view nephrologist part broad health care team coordinating care thus comparing reports esrd patients patients complex chronic illnesses malignancies diabetes care may rendered multidisciplinary team may informative despite concerns paper paddison et al important advance way esrd providers thinking patient care essential quality safety efficacy standards maintained need focus additional attention patients experiences perceptions care need identify domains concern importance patients need understand care modified improve patients experience perceptions identify barriers impediments may compromise patient care undermine best efforts improve outcomes support none financial disclosure authors declare relevant financial interests experiences care among medicare beneficiaries esrd medicare consumer assessment healthcare providers systems cahps survey resultsamerican journal kidney diseasesvol 61issue 3previewpatients endstage renal disease esrd special health needs little known care experiences fulltext pdf open access