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Palliative Care Disincentives in CKD: Changing Policy to Improve CKD Care

Authors :
Alvin H. Moss
Laura M. Holdsworth
Elizabeth Malcolm
Ann M. O’Hare
Manjula Kurella Tamura
Eugene Lin
Source :
American Journal of Kidney Diseases. 71:866-873
Publication Year :
2018
Publisher :
Elsevier BV, 2018.

Abstract

The dominant health delivery model for advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States, which focuses on provision of dialysis, is ill-equipped to address many of the needs of seriously ill patients. Although palliative care may address some of these gaps in care, its integration into advanced CKD care has been suboptimal due to several health system barriers. These barriers include uneven access to specialty palliative care services, under-developed models of care for seriously ill patients with advanced CKD, and misaligned policy incentives. This article reviews policies that affect the delivery of palliative care for this population, discusses reforms that could address disincentives to palliative care, identifies quality measurement issues for palliative care for individuals with advanced CKD and ESRD, and considers potential pitfalls in the implementation of new models of integrated palliative care. Reforming healthcare delivery in ways that remove policy disincentives to palliative care for patients with advanced CKD and ESRD will fill a critical gap in care.

Details

ISSN :
02726386
Volume :
71
Database :
OpenAIRE
Journal :
American Journal of Kidney Diseases
Accession number :
edsair.doi.dedup.....a1dcb3a6d5f0b1f65fefe0d2c1beb41e
Full Text :
https://doi.org/10.1053/j.ajkd.2017.12.017