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https://www.readbyqxmd.com/read/26814215/a-survey-of-views-and-practice-patterns-of-dialysis-medical-directors-toward-end-of-life-decision-making-for-patients-with-end-stage-renal-disease
#1
Enrica Fung, Nate Slesnick, Manjula Kurella Tamura, Brigitte Schiller
BACKGROUND: Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied. AIM: Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD. DESIGN: We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013...
July 2016: Palliative Medicine
https://www.readbyqxmd.com/read/25662834/trends-in-us-vascular-access-use-patient-preferences-and-related-practices-an-update-from-the-us-dopps-practice-monitor-with-international-comparisons
#2
Ronald L Pisoni, Lindsay Zepel, Friedrich K Port, Bruce M Robinson
BACKGROUND: Since the bundled end-stage renal disease prospective payment system began in 2011 in the United States, some hemodialysis practices have changed substantially, raising the question of whether vascular access practice also has changed. We describe monthly US vascular access use from August 2010 to August 2013 with international comparisons, and other aspects of US vascular access practice. STUDY DESIGN: Prospective observational cohort study of vascular access...
June 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/25403921/managing-disruptive-behavior-by-patients-and-physicians-a-responsibility-of-the-dialysis-facility-medical-director
#3
Edward R Jones, Richard S Goldman
The Centers for Medicare & Medicaid Services' Conditions for Coverage make the medical director of an ESRD facility responsible for all aspects of care, including high-quality health care delivery (e.g., safe, effective, timely, efficient, and patient centered). Because of the high-pressure environment of the dialysis facility, conflicts are common. Conflict frequently occurs when aberrant behaviors disrupt the dialysis facility. Patients, family members, friends, and, less commonly appreciated, nephrology clinicians (i...
August 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/25376762/the-medical-director-and-quality-requirements-in-the-dialysis-facility
#4
Brigitte Schiller
Four decades after the successful implementation of the ESRD program currently providing life-saving dialysis therapy to >430,000 patients, the definitions of and demands for a high-quality program have evolved and increased at the same time. Through substantial technological advances ESRD care improved, with a predominant focus on the technical aspects of care and the introduction of medications such as erythropoiesis-stimulating agents and active vitamin D for anemia and bone disease management. Despite many advances, the size of the program and the increasingly older and multimorbid patient population have contributed to continuing challenges for providing consistently high-quality care...
March 6, 2015: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/25352380/the-medical-director-in-integrated-clinical-care-models
#5
REVIEW
Thomas F Parker, George R Aronoff
Integrated clinical care models, like Accountable Care Organizations and ESRD Seamless Care Organizations, present new opportunities for dialysis facility medical directors to affect changes in care that result in improved patient outcomes. Currently, there is little scholarly information on what role the medical director should play. In this opinion-based review, it is predicted that dialysis providers, the hospitals in which the medical director and staff physicians practice, and the payers with which they contract are going to insist that, as care becomes more integrated, dialysis facility medical directors participate in new ways to improve quality and decrease the costs of care...
July 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/25278550/the-evolving-role-of-the-medical-director-of-a-dialysis-facility
#6
Franklin W Maddux, Allen R Nissenson
The medical director has been a part of the fabric of Medicare's ESRD program since entitlement was extended under Section 299I of Public Law 92-603, passed on October 30, 1972, and implemented with the Conditions for Coverage that set out rules for administration and oversight of the care provided in the dialysis facility. The role of the medical director has progressively increased over time to effectively extend to the physicians serving in this role both the responsibility and accountability for the performance and reliability related to the care provided in the dialysis facility...
February 6, 2015: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/25255911/medical-director-responsibilities-to-the-esrd-network
#7
Peter B DeOreo, Jay B Wish
The 18 regional ESRD Networks are established in legislation and contract with the Centers for Medicare and Medicaid Services to improve the quality and safety of dialysis, maximize patient rehabilitation, encourage collaboration among and between providers toward common quality goals, and improve the reliability and the use of data in pursuit of quality improvement. The Networks are funded by a $0.50 per treatment fee deducted from the reimbursement to dialysis providers, and their deliverables are determined by a statement of work, which is updated in a new contract every 3 years...
October 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/24279209/challenges-for-dialysis-facility-medical-directors-and-impact-on-patient-care
#8
Robert J Kossmann
My service within the RPA began with my need to be a part of the solution, to help navigate the direction of inevitable change, and to ensure we do not lose focus of our ultimate goal as nephrologists-the provision of excellent kidney care. I would encourage all of you to participate in this process as well. It is essential that we maintain our independence, ethics and principals, and excellence in our roles and responsibilities as nephrologists and dialysis unit medical directors, especially in challenging times such as these...
October 2013: Nephrology News & Issues
https://www.readbyqxmd.com/read/23921479/department-of-nephrology-at-the-medical-faculty-ss-cyril-and-methodius-university-skopje-creating-nephrology-protection-for-the-citizens-of-the-republic-of-macedonia
#9
M Polenakovic
In January 1975, de facto, the Nephrology Department was founded at the Medical Faculty in Skopje as the first institution of such a type in former Yugoslavia. The Nephrology Department was the driving force for the further development of nephrology in the Republic of Macedonia. D. Hrisoho was the first Director of the Department, and its subsequent Directors were G. Masin, M. Polenakovic, K. Zafirovska and currently A. Sikole. Prior to the establishment of the Nephrology Clinic there had been considerable experience in the diagnosis and treatment of renal patients...
2013: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
https://www.readbyqxmd.com/read/23580784/american-society-of-nephrology-quiz-and-questionnaire-2012-electrolytes
#10
Biff F Palmer, Richard J Glassock, Anthony J Bleyer
Presentation of the Nephrology Quiz and Questionnaire has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, with the answers of program directors of nephrology training programs in the United States acquired through an Internet-based questionnaire...
June 2013: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/23559678/american-society-of-nephrology-quiz-and-questionnaire-2012-renal-replacement-therapy
#11
Rajnish Mehrotra, Richard J Glassock, Anthony J Bleyer
Presentation of the Nephrology Quiz and Questionnaire has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, with the answers of program directors of nephrology training programs in the United States acquired through an Internet-based questionnaire...
September 2013: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/23539230/american-society-of-nephrology-quiz-and-questionnaire-2012-transplantation
#12
Daniel C Brennan, Richard J Glassock, Anthony J Bleyer
Presentation of the Nephrology Quiz and Questionnaire has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session, as judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time, using audience response devices, to those of program directors of nephrology training programs in the United States, acquired through an Internet-based questionnaire...
July 2013: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/23332603/why-not-nephrology-a-survey-of-us-internal-medicine-subspecialty-fellows
#13
Kenar D Jhaveri, Matthew A Sparks, Hitesh H Shah, Seyyar Khan, Arun Chawla, Tejas Desai, Edward Iglesia, Maria Ferris, Mark G Parker, Donald E Kohan
BACKGROUND: There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology. METHODS: A web-based survey with multiple choice, yes/no, and open-ended questions was sent in summer 2011 to trainees reached through internal medicine subspecialty program directors...
April 2013: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/22536078/evaluation-of-deficiencies-in-current-discharge-summaries-for-dialysis-patients-in-canada
#14
Ziv Harel, Ron Wald, Jeff Perl, Daniel Schwartz, Chaim M Bell
BACKGROUND: Deficits in the transfer of information between inpatient and outpatient physicians are common and pose a patient safety risk. This is particularly the case for vulnerable populations such as patients with end-stage renal disease requiring dialysis. These patients have unique and complex health care needs that may not be effectively communicated on standard discharge summaries, which may result in potential medical errors and adverse events. OBJECTIVE: To evaluate Canadian dialysis center directors' perceptions of deficiencies in the content and quality of hospital discharge summaries for dialysis patients...
2012: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/20017841/focused-vascular-access-education-to-reduce-the-use-of-chronic-tunneled-hemodialysis-catheters-results-of-a-network-quality-improvement-initiative
#15
Deuzimar Kulawik, Jeffrey J Sands, Kelly Mayo, Mary Fenderson, Janet Hutchinson, Cindy Woodward, Sally Gore, Arif Asif
Tunneled hemodialysis catheters (TDCs) carry the highest mortality risk for chronic hemodialysis patients of any access modality. Recent data have emphasized that mortality risk decreases when these devices are discontinued. Herein, we present the results of a gap-reduction assisted catheter elimination strategy that Network 7 employed as its quality improvement initiative to reduce the use of TDCs. Hemodialysis facilities with high catheter rates (>90 days) were identified. Interventions included focused vascular access education, monthly follow-up and site visits to assist the facility catheter reduction program...
November 2009: Seminars in Dialysis
https://www.readbyqxmd.com/read/19169012/the-medical-directorship-of-renal-dialysis-facilities-under-the-new-medicare-conditions-for-coverage-challenges-and-opportunities
#16
Peter B DeOreo
The new Medicare conditions for coverage for providers of end-stage renal disease services provide both a challenge and an opportunity for medical directors. The conditions expect active clinical leadership in quality improvement and the performance of the facility staff and medical staff. These new rules define patient assessment and care planning processes that complement the quality assessment and performance improvement (QAPI) program. Infection control, patient safety and error reduction are given new emphasis...
2009: Blood Purification
https://www.readbyqxmd.com/read/18533968/medical-director-responsibilities-regarding-disruptive-behavior-in-the-dialysis-center-leading-effective-conflict-resolution
#17
Richard S Goldman
Medical directors are directly or indirectly responsible for everything that occurs in a dialysis facility. The proposed Conditions of Coverage require medical directors to oversee the process resulting in involuntary discharges from the facility. Involuntary discharges result in high costs to the patient, family, facility and payers. Consequently, End Stage Renal Disease (ESRD) Networks oversee individual facility involuntary discharge rates. A large national survey found that involuntary discharges were due to disruptive behaviors, most commonly nonadherence to medical advice...
May 2008: Seminars in Dialysis
https://www.readbyqxmd.com/read/18511606/vascular-access-use-and-outcomes-an-international-perspective-from-the-dialysis-outcomes-and-practice-patterns-study
#18
MULTICENTER STUDY
Jean Ethier, David C Mendelssohn, Stacey J Elder, Takeshi Hasegawa, Tadao Akizawa, Takashi Akiba, Bernard J Canaud, Ronald L Pisoni
BACKGROUND: A well-functioning vascular access (VA) is essential to efficient dialysis therapy. Guidelines have been implemented improving care, yet access use varies widely across countries and VA complications remain a problem. This study took advantage of the unique opportunity to utilize data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to examine international trends in VA use and trends in patient characteristics and practices associated with VA use from 1996 to 2007...
October 2008: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/18251959/the-role-of-the-medical-director-changing-with-the-times
#19
REVIEW
Franklin W Maddux, Dugan W Maddux, Raymond M Hakim
The role of the dialysis unit Medical Director has evolved over time to an expanded set of roles from one that used to be strictly "medical" to one that is more "managerial." Physicians providing these Medical Director services are facing increasing demands for a leadership role regarding clinical quality improvement and measurement of performance in core areas of care within the dialysis program. The dialysis Medical Director is asked to lead in group decision-making, in analyzing core process and patient outcomes and in stimulating a team approach to Continuous Quality Improvement (CQI) and patient safety...
January 2008: Seminars in Dialysis
https://www.readbyqxmd.com/read/18086259/how-dialysis-is-paid-for-what-the-dialysis-medical-director-should-know-and-why
#20
REVIEW
Peter B Deoreo
While Medicare funds neither 100% of the patients, nor 100% of the costs incurred by dialysis patients, Medicare's policies dominate reimbursement. The medical director is well advised to understand these mechanisms and the processes leading to change. Medicare pays for dialysis according to laws and rules enacted by Congress. Congress is re-evaluating the funding of the end-stage renal disease program. The rules are changing. They are changing in a way designed to encourage better outcomes, and increased provider accountability...
January 2008: Seminars in Dialysis
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