Impact of Adherence to Anemia Management Policy on Repeat Hospitalization in End Stage Renal Disease (ESRD)

NCT ID: NCT01017627

Last Updated: 2010-04-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-11-30

Study Completion Date

2010-12-31

Brief Summary

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The investigators hypothesize that the post-hospitalized patient status is characterized by subacute and reversible metabolic and hematological changes that, if addressed and treated in a timely manner, would result in a reduced risk for repeat hospitalization. Consequently, a structured quality improvement program, focused on increasing adherence to company wide anemia management policies (ie hemoglobin monitoring within the first 3-5 days post-hospitalization, followed by an appropriate EPO dose modification within the 7 days post-hospitalization), will significantly decrease the risk of hospital re-admission in the 30 days after discharge.

Detailed Description

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The post-hospitalization quality improvement project will be piloted across 30 Fresenius clinics. Targeted enrollment of 1500 episodes of hospitalization in which the patient returns after discharge to resume outpatient dialysis.

Patient outcomes will be followed for up to 30 days from the time of discharge from hospital.

Conditions

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Anemia Mortality

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Early anemia management

Upon return to the dialysis unit following hospitalization, patients will be immediately identified and have immediate implementation of the unit anemia protocol rather than waiting for the next regularly scheduled unit labs and regular follow-up. Thus, labs will be obtained within the first 3-7 days following hospitalization and appropriate titration of Epo and iron medications within the 7 days after discharge from hospital and under the direction of the pre-specified algorithm used in the patient's facility; all drug dosing will comply with package insert instructions

Group Type OTHER

Early anemia diagnosis and treatment

Intervention Type OTHER

Patients returning to the unit are immediately assessed and treated for anemia

case control

Each case will be "data-matched" to an intra-facility (primary control), and then an inter-facility (validation control) control patient. Matching criteria will be by age, gender, diabetic status, attending nephrologist, length of hospitalization stay, and hospital discharge date (to minimize the difference in the date between the case and control). These patients did not have early intervention but followed the usual practice of waiting for the next regularly scheduled dialysis unit labs with anemia management to follow using the regular unit algorithm.

Group Type OTHER

No change from normal routine

Intervention Type OTHER

Normal unit policy for labs and anemia treatment

Interventions

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Early anemia diagnosis and treatment

Patients returning to the unit are immediately assessed and treated for anemia

Intervention Type OTHER

No change from normal routine

Normal unit policy for labs and anemia treatment

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* age ≥ 18
* resumption of routine outpatient chronic hemodialysis within three days of discharge from hospital admission
* enrolled in a facility-based anemia management program

Exclusion Criteria

* enrolled in hospice
* previous hospitalization within the past 30 days (ie. patients discharged from a repeat hospitalization)
* anticipated discharge from the outpatient dialysis facility within 30 days (ie anticipated transfer to another facility or hospice)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fresenius Medical Care North America

INDUSTRY

Sponsor Role lead

Responsible Party

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Fresenius Medical Care North America

Principal Investigators

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Raymond Hakim, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Fresenius Medical Services

Locations

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Denver Central

Denver, Colorado, United States

Site Status

St. John's

Jacksonville, Florida, United States

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JAX Beach

Jacksonville, Florida, United States

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Prairie

Chicago, Illinois, United States

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Tri Counties

Decatur, Indiana, United States

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Huntington

Huntington, Indiana, United States

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Floyd County

New Albany, Indiana, United States

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South Louisville

Louisville, Kentucky, United States

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Breaux Bridge

Breaux Bridge, Louisiana, United States

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Delta

Delta, Louisiana, United States

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East Lafayette

Lafayette, Louisiana, United States

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Methuen

Methuen, Massachusetts, United States

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Roxbury

Roxbury, Massachusetts, United States

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Battle Creek

Battle Creek, Michigan, United States

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East Lansing

East Lansing, Michigan, United States

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Oshtemo

Kalamazoo, Michigan, United States

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Lansing

Lansing, Michigan, United States

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Saganaw Riverside

Saginaw, Michigan, United States

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Saginaw

Saginaw, Michigan, United States

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Eupora

Eupora, Mississippi, United States

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Meridian

Meridian, Mississippi, United States

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Yokna River

Oxford, Mississippi, United States

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Independence Centerpoint

Independence, Missouri, United States

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Desert Inn

Las Vegas, Nevada, United States

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South Pecos

Las Vegas, Nevada, United States

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Briggs Ave

Durham, North Carolina, United States

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Freedom Lake

Durham, North Carolina, United States

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Boardman

Boardman, Ohio, United States

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Cortland

Cortland, Ohio, United States

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Elyria

Elyria, Ohio, United States

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North Randall

North Randall, Ohio, United States

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Westlake

Westlake, Ohio, United States

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Willoughby

Willoughby, Ohio, United States

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Twin Oaks

Beaverton, Oregon, United States

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Clackamas

Clackamas, Oregon, United States

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Fresenius Medical Services

Brentwood, Tennessee, United States

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Smyrna

Smyrna, Tennessee, United States

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West Nashville

West Nashville, Tennessee, United States

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North Fort Worth

Fort Worth, Texas, United States

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Tarrant County

Fort Worth, Texas, United States

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Waco

Waco, Texas, United States

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Waco West

Waco, Texas, United States

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Countries

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United States

References

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Wingard RL, Pupim LB, Krishnan M, Shintani A, Ikizler TA, Hakim RM. Early intervention improves mortality and hospitalization rates in incident hemodialysis patients: RightStart program. Clin J Am Soc Nephrol. 2007 Nov;2(6):1170-5. doi: 10.2215/CJN.04261206. Epub 2007 Oct 17.

Reference Type BACKGROUND
PMID: 17942761 (View on PubMed)

Other Identifiers

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20090068

Identifier Type: -

Identifier Source: org_study_id

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