Health Care Highlight: Measuring and Improving the Health Status of End Stage Renal Disease Patients

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Abstract

This highlight reports on recent efforts to develop and promote health status measurement instruments for use in dialysis units that treat end-stage renal disease (ESRD) patients, most of whom are covered for all medical services under Medicare. Readers interested in a more detailed discussion of instruments, including associated data collection and data processing aspects, should consult a recently published account, with its extensive references, of four instruments currently being used in dialysis units ( Rettig et al, 1997). Those interested in early reports of the clinical utility of such instruments should consult the following references ( Kurtin et al, 1992; Meyer et al., 1994; and DeOreo, 1997).

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Most cited references 17

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Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance.

P B DeOreo (1997)

We asked patients to assess their functional health status by completing the SF-36. Over 2 years, we studied 1,000 patients (average age, 58 years; 50% male; 25% white; 36% diabetic) in three outpatient, staff-assisted hemodialysis units. We used both the eight-scale scores and two-component summary scores to study the relationship between baseline functional health status and clinical outcomes. The physical component summary (PCS) score was as significant a predictor of mortality as was the normalized protein catabolic rate or the delivered Kt/V. Patients with a PCS score below the median for our patients (< 34) were twice as likely to die and 1.5 times more likely to be hospitalized as patients with PCS scores at or above the median score. Either a low PCS score or a low mental component summary (MCS) score correlated with the number of days of hospitalization. While the average dialysis patient has a relatively normal (47 v 50) MCS score and a low (37 v 50) PCS score compared with the normal population, patients who skipped more than two treatments per month tended to have a relatively higher PCS score (judged themselves physically healthier) and a relatively lower MCS score (judged themselves less mentally healthy) than patients who did not skip two or more treatments per month. The prevalence of depression as defined by an MCS score of < or = 42 was approximately 25%. The SF-36 provided a good screening tool for patients at high risk for death, hospitalization, poor attendance, and depression.

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End-stage renal disease in African-American and white men. 16-year MRFIT findings.

M Klag, P K Whelton, B L Randall … (2015)

To determine reasons for the 4-fold higher incidence of treated end-stage renal disease (ESRD) in African-American men compared with white men. Prospective study. Men screened in 1973 through 1975 for entry into the Multiple Risk Factor Intervention Trial (MRFIT). A total of 332544 men (300645 white, 20222 African American, and 11677 other ethnic groups) aged 35 to 57 years. Incidence of ESRD assessed through 1990 using the Health Care Financing Administration national ESRD treatment registry and by surveillance for death from renal disease from data of the National Death Index and the Social Security Administration. Over a mean follow-up of 16 years, age-adjusted ESRD incidence was 13.90 per 100000 person-years in white men and 44.22 per 100000 person-years in African-American men. Higher blood pressure and lower socioeconomic status were associated with higher incidence of ESRD in both ethnic groups. With adjustment for baseline age, systolic blood pressure, number of cigarettes smoked, previous myocardial infarction, diabetes, income, and serum cholesterol level, relative risk of ESRD in African-American men compared with white men was reduced from 3.20 to 1.87 (95% confidence interval, 1.47-2.39). Both higher systolic blood pressure and lower income in African-American men as compared with white men were particularly related to this reduced relative risk. Results were similar when hypertensive ESRD was used as the outcome. Both higher blood pressure and lower income are associated with a higher incidence of ESRD in both white and African-American men. Disparities in blood pressure and socioeconomic status relate importantly to the excess risk of ESRD in African-American men compared with white men.

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The Duke Health Profile. A 17-item measure of health and dysfunction.

Vicki C Tse, W E Broadhead, George Parkerson (1990)

The Duke Health Profile (DUKE) is a 17-item generic self-report instrument containing six health measures (physical, mental, social, general, perceived health, and self-esteem), and four dysfunction measures (anxiety, depression, pain, and disability). Items were derived from the 63-item Duke-UNC Health Profile, based upon face validity and item-remainder correlations. The study population included 683 primary care adult patients. Reliability was supported by Cronbach's alphas (0.55 to 0.78) and test-retest correlations (0.30 to 0.78). Convergent and discriminant validity were demonstrated by score correlations between the DUKE and the Sickness Impact Profile, the Tennessee Self-Concept Scale, and the Zung Self-Rating Depression Scale. Clinical validity was supported by differences between the health scores of patients with clinically different health problems. Patients with painful physical problems had a DUKE physical health mean score of 58.1, while patients with only health maintenance problems had a mean score of 83.9 (scale: 0.0 = poorest health and 100.0 = best health). Patients with mental health problems had a DUKE mental health mean score of 49.2, in contrast to 75.7 for patients with painful physical problems and 79.2 for those with health maintenance. The DUKE is presented as a brief technique for measuring health as an outcome of medical intervention and health promotion.

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Journal ID (nlm-ta): Health Care Financ Rev

Journal ID (iso-abbrev): Health Care Financ Rev

Journal ID (publisher-id): HCFR

Title: Health Care Financing Review

Publisher: CENTERS for MEDICARE & MEDICAID SERVICES

ISSN (Print): 0195-8631

ISSN (Electronic): 1554-9887

Publication date (Print): Summer 1997

Volume: 18

Issue: 4

Pages: 77-82

Article

Publisher ID: hcfr-18-4-77

PMC ID: 4194469

PubMed ID: 10175614

SO-VID: faee66c9-fea2-4e47-aa94-577cead7505a

Health Care Highlight: Measuring and Improving the Health Status of End Stage Renal Disease Patients

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Most cited references 17

Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance.

End-stage renal disease in African-American and white men. 16-year MRFIT findings.

The Duke Health Profile. A 17-item measure of health and dysfunction.

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