Evaluating a novel health system intervention for chronic kidney disease care using the RE-AIM framework: Insights after two years

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• 作者：Denise M. Hynes ; MPH ; PhD ; RN^a ; ^b ; ^c ; ^d ; ^e ; ^{dhynes@uic.edu} ; Michael J. Fischer ; MD ; MSPH^e ; ^f ; ^g ; Linda A. Schiffer ; MS^a ; Rani Gallardo ; MS^h ; Ifeanyi Beverly Chukwudozie ; MPH^a ; ^b ; Anna Porter ; MD^f ; Michael Berbaum ; PhD^b ; ^c ; Jennifer Earheart ; MA^a ; Marian L. Fitzgibbon ; PhD^c ; ⁱ
• 关键词：Chronic kidney disease ; Patient centered medical home ; Medical home ; Implementation science
• 刊名：Contemporary Clinical Trials
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：Complete
• 页码：20-26
• 全文大小：351 K
• 卷排序：52

文摘

Using a quasi-experimental design, we implemented the Patient-Centered Medical Home for Kidney Disease (PCMH-KD), a comprehensive, multidisciplinary care team to improve quality of life and healthcare coordination for adult chronic hemodialysis (CHD) patients. This paper highlights our experience in the first two years of the study. We focus on the process dimensions of Reach, Adoption, and Implementation within the context of the RE-AIM framework.Materials and methodsWe established a new PCMH-KD model at two outpatient dialysis centers. During the intervention phase, adult patients were recruited for participation and data collection. We monitored RE-AIM measures to identify areas for potential adaptation of the care model.ResultsDuring the start-up phase, we engaged patients and stakeholders in planning the intervention, established the new PCMH-KD team, and trained new and continuing clinicians and staff at two dialysis centers. In the intervention phase we recruited 155 patients to participate. Patients had individual visits with the PCP (40%) and the CHWs (92%) (Reach). Patient feedback informed procedures for appointment scheduling (Adoption). The new PCMH-KD team members were consistent in their roles. With staff changes, some responsibilities were adapted for cross coverage (Implementation).ImplicationsAfter one year of start-up and one year of intervention, active monitoring of Reach, Implementation and Adoption measures have facilitated necessary adaptions in the planned intervention to accommodate scheduling demands and patient feedback in the PCMH-KD model. Insights from this trial may inform care of CHD patients more broadly.