Effectiveness of Dialysis Transition Unit to Improve Patients' Decision-Making and Self-Management Skills

Background: Dialysis initiation is a stressful time for people living with kidney failure. As a quality improvement initiative, we created a dialysis transition unit (DTU) in Calgary, Alberta with the goal of providing person-focused dialysis care for patients starting hemodialysis. Objectives:To compare patient’s perception of participation in self-management and receipt of dialysis transition/chronic care counseling using PACIC-20, (Patient Assessment of Chronic Illness Care) between patients starting hemodialysis in the DTU and in a traditional facility-based HD unit (HDU). Methods: PACIC-20, anxiety (GAD-7) and depression (PHQ-9) scores were captured prospectively (June 1, 2021-June 30, 2022) on patients starting hemodialysis on the DTU and the HDU at dialysis initiation and two weeks later. Our primary outcome of interest was between-group differences in PACIC-20 scores at 2 weeks after dialysis initiation. Secondary outcomes included between-group differences in PACIC-20 subcategories and between-group differences for the change in patient-reported outcome measures of GAD-7 and PHQ-9 at 2 weeks. Results: A total of 26 DTU and 26 HDU participants completed data collection (mean age 62.6 ± 17.7 years; 42.3% females). The PACIC-20 scores at two weeks were similar (DTU 3.60 ± 0.6 and HDU 3.26 ± 0.95, P = 0.21). All PACIC-20 subcategories were similar between groups except for problem solving, which trended higher in DTU (4.09 ± 0.9 vs 3.39± 1.36, p=0.06). The subcategory, patient activation was associated with improved anxiety in DTU (p= 0.02) but not HDU (p= 0.35). The between-group difference was significant for PHQ-9 for DTU (p= 0.007) but non-significant for GAD-7 (p=0.05). Conclusion: While we did not find a significant difference in the overall patient perception of self management (PACIC-20) when transitioning to a specialized DTU (vs HDU), we did find improved problem-solving scores and lower depression scores for DTU. Further research on the role of a DTU to optimize patient care is needed.