Use of Dialysis Educators Beyond Nurses and Physicians and Outcomes in Patients With Kidney Failure
This study examined whether patient education by nonmedical personnel (eg, social workers, dietitians) is associated with patient outcomes in a prospective cohort study of 1,005 incident dialysis patients treated at 79 United States clinics. Logistic and Poisson regression and Cox proportional hazards models were used to assess the relationship between clinic use of nonmedical educators and patient satisfaction and self-management, hospitalization, and survival, respectively. Patients treated at clinics reporting use of nonmedical educators (84%) were more likely to be satisfied with the amount of information on dialysis modalities (odds ratio [OR] =1.67, 95% confidence interval [CI] 1.08-2.58) and with the amount of information they received on dialysis (OR = 1.23, 95% CI 0.90-1.67; marginally significant) than those treated at clinics without nonmedical educators (16%). These patients were also less likely to be hospitalized (incidence rate ratio [IRR] = 0.91, 95% CI 0.80-1.03), but the association was of borderline statistical significance. Overall satisfaction, patient self-management, and mortality were not significantly associated with use of nonmedical educators. Use of nonmedical staff for patient education at dialysis centers has a limited but positive effect on patient satisfaction and hospitalization.
aDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
bCenter for Studying Health System Change, Washington, DC
cDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
dDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Address correspondence to Neil R. Powe, MD, MPH, MBA, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205
Supported by grant no. RO1 DK 59616 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, grant no. R01HS08365 from the Agency for Health Care Research and Quality, Rockville, Maryland and grant no. R01 HL 62985 from the National Heart, Lung, and Blood Institute, Bethesda, MD. Dr. Pham was supported by grant no. T32 HL07180 from the National Heart, Lung, and Blood Institute. Dr. Jaar is supported in part by the Richard Ross Clinician Scientist Award from the Johns Hopkins School of Medicine. Dr. Powe is supported by grant K24DK02643. We thank the patients, staff, and medical directors of the participating centers at DCI, New Haven CAPD, and St. Raphael’s Hospital who contributed to the study.
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