提升末期腎病病人預先建立透析動靜脈瘻管完成率

Improving Completion Rate of Pre-Dialysis Arteriovenous Access in Patients With End-Stage Renal Disease

背景：末期腎病病人於透析前若沒有預先建立透析動靜脈瘻管，則需使用短期通路透析，因而影響病人生活品質及存活率，本單位統計2021年6月至2022年5月末期腎病病人預先建立透析動靜脈瘻管完成率僅20.4%。分析原因為：（一）病人或家屬認知正確率僅49.3%；（二）個管師衛教方式不一致；（三）執行醫病共享決策（shared decision making）後沒有後續追蹤病人的抉擇；（四）病人告知透析模式意願後，缺乏溝通平台，導致預先建立透析通路的告知時機不一致。
目的：末期腎病病人預先建立透析動靜脈瘻管完成率提升至40.1%。
解決方案：（一）增加輔助教學工具、（二）優化衛教工具及流程、（三）強化醫病共享決策追蹤機制。
結果：末期腎病病人預先建立透析動靜脈瘻管完成率由20.4%提升至41.2%。
結論：除了達到本專案之目的外，其附加效益為降低病人住院天數、減少醫療耗材成本支出。

Background & Problems: In patients with end-stage renal disease (ESRD), not establishing arteriovenous access prior to the commencement of dialysis necessitates the use of temporary vascular access, which negatively impacts quality of life and survival. Statistics for the period June 2021 to May 2022 showed the rate of completion of arteriovenous (AV) access in patients with ESRD in our hospital to be only 20.4%. The identified reasons for this low rate were: (1) only 49.3% of patients / family members had correct knowledge regarding the establishment of AV access; (2) relevant education methods varied among case managers; (3) patient decisions were not queried after implementing shared decision-making; (4) no structured communication platform was available to patients after expressing their preferred dialysis modality, leading to inconsistencies in receiving relevant education and establishing AV access.
Purpose: The objective of this project was to raise the pre-dialysis AV access completion rate in patients with ESRD to 40.1%.
Resolution: (1) Add auxiliary educational tools; (2) optimize education materials and processes; and (3) strengthen the shared-decision making tracking mechanism.
Result: The completion rate of pre-dialysis AV access increased from 20.4% to 41.2% in the target patient group.
Conclusion: In addition to meeting the main objective, additional benefits of the project included reduced average hospitalization duration and lower consumption of medical consumables per patient.