Dialysis Transportation: The Intersection of Transportation and Healthcare (2019) / Chapter Skim
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Pages 15-26
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Introduction Chronic kidney disease has reached a crisis in the United States -- for both medical care and public policy (1)
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End Stage Renal Disease At the last stage of chronic kidney disease -- end stage renal disease or ESRD -- the kidneys no longer work well enough for a person to survive without treatment. Causes of ESRD Diabetes is the most common cause of ESRD, followed by high blood pressure.
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What Are the Treatments for ESRD? There are three treatment options for ESRD: kidney transplantation, dialysis, and palliative care.
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Process for In-center Hemodialysis and Home Dialysis (Source: GAO, Figure 1, used with permission, p.
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Peritoneal Dialysis In peritoneal dialysis (PD) , a catheter is placed within the patient's abdomen through surgery.
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Transportation for ESRD patients treated at facilities has an over-sized role -- 312 trips annually -- essential for the patients' survival. Photo courtesy of KFH Group.
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HD Machines in a Dialysis Facility Photo courtesy of KFH Group. Incident Patients Versus Prevalent Patients When looking at treatment modality, incident (new)
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• The patient's preference and capability to manage home dialysis. o Some patients feel that is safer to have treatment in a medical facility rather than at home.
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PD Machine for Home Use Photo courtesy of KFH Group. Why Did Home Dialysis Decrease from 1988 to 2008?
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Impacts of Medicare Payment The GAO report found that Medicare payments to dialysis facilities gave them an overall �inancial incentive to provide dialysis and most likely a �inancial incentive to encourage the use of peritoneal dialysis over the long run. Reportedly, the cost of peritoneal dialysis is generally lower than hemodialysis.
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Two universities are working together toward this goal through a national research project known as The Kidney Project. The developers' device uses microchip filters and living kidney cells that would be powered by a patient's heart.
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