PEAK CAMPAIGN LEARNING CENTER
Throughout the Campaign, the PEAK Learning Center will feature approaches that providers, health care professionals, and patients can focus on to improve survival in their first year of dialysis.
The RightStart Program
Using a systematic case management approach that focused on patient education coupled with clinical interventions targeting five areas—anemia management, adequate dialysis dose, nutrition, reduction of catheter use, review of medications—the RightStart Program achieved significant reductions in first-year mortality and hospitalizations. (See entire abstract)
Under RightStart, a nurse case manager followed each new RightStart patient during his/her initial three months of dialysis (The initial pilot excluded patients who might have difficulties participating in the intensive patient education/self-management component of the program.) On average, the case manager met with the patient 1-2 times/week during the first month and every 1-2 weeks for the following 2 months. In addition to specific clinical goals under the program, logistical support, psychosocial assessment with appropriate referral to social services, and encouragement to participate in self-care and rehabilitation services also were emphasized.
Results from RightStart were striking:
- At 90 days, the annualized mortality rate in the intervention population of
HD patients compared to the control was reduced from 39% to 20%.
- At 180 days, the rate was reduced from 33% to 18%.
- At one year, the rate was reduced from 30% to 17%.
Overall, the RightStart program reduced first-year mortality by 41%.
Currently, the program (now extended to the first four months of dialysis)
is being used on a broader population.
Using more current data from the Centers for Medicare and Medicaid Services
and the USRDS methodology, the PEAK campaign will report the progress toward
reaching its goal of improving patient survival by reducing first-year
mortality by 20% by the end of 2012.
Campaign Learning Center Resources
The RightStart Program Presentation
Dr. Ray Hakim, March 12, 2009
Early Intervention Improves Mortality and Hospitalization Rates in Incident Hemodialysis Patients: RightStart Program