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10.1053/j.ajkd.2015.11.024 http://scihub22266oqcxt.onion/10.1053/j.ajkd.2015.11.024 C4921274!4921274!26806003     free     free     free Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Am+J+Kidney+Dis 2016 ; 68 (1): 103-9 Nephropedia Template TP {{tp|p=26806003|t=2016. Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project |pdf=|usr=}}{{26806003}} gab.com Text Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project JO: Am J Kidney Dis http://www.kidney.de/pget.php?&tw=1&pmid=26806003 #FOAvip Background: The Renal Physicians Association?s clinical practice guideline recommends that physicians address advance care planning with dialysis patients. Data are lacking, however, about how best to implement this recommendation. Study Design: Quality improvement project in two Tufts-affiliated dialysis facilities in Boston, Massachusetts. Settings and Participants: Nephrologists caring for patients treated with maintenance hemodialysis at two facilities identified patients who might benefit most from advance care planning using the ?surprise? question (?Would I be surprised if this patient died in the next year??). Quality Improvement Plan: Patients identified with a ?no? response to the surprise question were invited to participate in nephrologist-facilitated advance care planning including the use of a medical Orders for Life-Sustaining Treatment (MOLST) form. Outcomes: Change in MOLST completion rate and identification of preferences for limits on life-sustaining treatment. Measurements: Pre- and post-intervention cardiopulmonary resuscitation status, MOLST completion rate, and vital status at one year were measured. Results: Nephrologists answered ?no? to the surprise question for 50 of 201 hemodialysis patients (25%). Of these, 41 (82%) patients had a ?full-code? status and 9 (18%) had a ?do not resuscitate? (DNR) status. Encounters lasted 15?60 minutes. Following the encounter, 21 (42%) patients expressed preference for a ?DNR? status and 29 (58%) maintained full-code status (p = 0.001). The MOLST completion rate increased from 10% to 90%. One-year survival for patients whose nephrologists answered ?no? to the surprise question was 58% compared with 92% for those with a ?yes? answer (p < 0.001). Limitations: Sample size and possible non-representative dialysis population. Conclusions: Nephrologist-facilitated advance care planning targeting hemodialysis patients with limited life expectancy led to significant changes in documented patient preferences for cardiopulmonary resuscitation and limits on life-sustaining treatment. These changes demonstrate the benefit of advance care planning with dialysis patients and likely reflect better understanding of end-of-life treatment options. Twit Text FOAVip Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project ????Am J Kidney Dis http://www.kidney.de/pget.php?&tw=1&pmid=26806003 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=26806003 #FOAvip English Wikipedia <ref>{{Cite pmid|26806003}}</ref> Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project #MMPMID26806003 Amro OW; Ramasamy M; Strom JA; Weiner DE; Jaber BL Am J Kidney Dis 2016[Jul]; 68 (1): 103-9 PMID26806003show ga Background: The Renal Physicians Association?s clinical practice guideline recommends that physicians address advance care planning with dialysis patients. Data are lacking, however, about how best to implement this recommendation. Study Design: Quality improvement project in two Tufts-affiliated dialysis facilities in Boston, Massachusetts. Settings and Participants: Nephrologists caring for patients treated with maintenance hemodialysis at two facilities identified patients who might benefit most from advance care planning using the ?surprise? question (?Would I be surprised if this patient died in the next year??). Quality Improvement Plan: Patients identified with a ?no? response to the surprise question were invited to participate in nephrologist-facilitated advance care planning including the use of a medical Orders for Life-Sustaining Treatment (MOLST) form. Outcomes: Change in MOLST completion rate and identification of preferences for limits on life-sustaining treatment. Measurements: Pre- and post-intervention cardiopulmonary resuscitation status, MOLST completion rate, and vital status at one year were measured. Results: Nephrologists answered ?no? to the surprise question for 50 of 201 hemodialysis patients (25%). Of these, 41 (82%) patients had a ?full-code? status and 9 (18%) had a ?do not resuscitate? (DNR) status. Encounters lasted 15?60 minutes. Following the encounter, 21 (42%) patients expressed preference for a ?DNR? status and 29 (58%) maintained full-code status (p = 0.001). The MOLST completion rate increased from 10% to 90%. One-year survival for patients whose nephrologists answered ?no? to the surprise question was 58% compared with 92% for those with a ?yes? answer (p < 0.001). Limitations: Sample size and possible non-representative dialysis population. Conclusions: Nephrologist-facilitated advance care planning targeting hemodialysis patients with limited life expectancy led to significant changes in documented patient preferences for cardiopulmonary resuscitation and limits on life-sustaining treatment. These changes demonstrate the benefit of advance care planning with dialysis patients and likely reflect better understanding of end-of-life treatment options. äNephrologist-Facilitated Advance Care Planning for Hemodialysis Patien(epmc).pdf DeepDyve Pubget Overpricing