Week 3 Discussion Post
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Dec 6, 2023
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Uploaded by DeanMole14034
DDHA 8051 Diefenderfer Week 3 Discussion
Meet Pam. She is a middle-class working patient with a high school education residing in Wichita,
Kansas. She has commercial insurance through her employer and has her family on the plan too. Pam
started experiencing shortness of breath and edema in her legs and landed in the ER. She was found to
have a history of type II diabetes and after lab work in the ER, it was noted her Creatinine was 6.5. She
was diagnosed with End-Stage Renal Disease requiring hemodialysis three times a week. The emergently
placed a CVC line to start dialysis and remove fluid on her heart and lungs.
ESRD is not a disease that you can recover from. The kidneys no longer function properly or at all
therefore the patient requires hemodialysis to clean the blood and remove toxins. The only possible way
to partially recover is a kidney transplant, which is a long journey in itself with a 7-year average waitlist if
you are approved after the workup. Even after the transplant, post-care and medication are required and
they are not guaranteed to last a lifetime. This indicator shows the percentage of Medicare beneficiaries
who were treated for chronic kidney disease in Kansas through 2018 (Kansas Health Matters, 2022). As
you can see, it is trending upward over time.
Now that Pam has been diagnosed with ESRD, she will require multiple providers to follow her care
along with outpatient services and procedures. First, Pam will need to find a nephrologist to care for her
kidneys as well as an endocrinologist to monitor her diabetes. The hospital is responsible for setting up
outpatient dialysis services for Pam, so they will admit and assign her to a chronic DaVita clinic in her
area near her home. Pam will have to attend her dialysis sessions at the facility three to four times a week.
She will also need to go to the vascular access center to get vein mapping completed so they can then
schedule a procedure for a fistula or graft placement. This shows the complexity of healthcare and more
specifically ESRD (Shi, L., & Singh, D. A. (2019).
There are several different types of dialysis modalities. Some are more beneficial for patients who are still
employed. There is the outpatient dialysis setting in a chronic center, Home Hemodialysis and Peritoneal
Dialysis. The dialysis outpatient centers are responsible for educating each new patient and all patients
annually on modality options per CMS requirements (DaVita, 2022). Since Pam is an employed patient,
she may choose to do the Home Hemo or PD dialysis at home in her convenience.
Medicare is the federal health insurance program for persons aged 65 years or older, persons under age 65
years with certain disabilities, and persons of any age with end-stage renal disease (ESRD). (Kansas
Health Matters, 2022).
One of the eligibility requirements for Medicare Part A & B coverage is End
Stage Renal Disease (ESRD). Once a patient is diagnosed with ESRD, they become eligible for Medicare
coverage. Pam’s dialysis center Social Worker will help her start the process for the coverage. The center
is required to completed a Medicare form called 2728 to inform CMS the patient has started on dialysis
and they begin the coverage process which back dates to the first day of dialysis for the patient. Her
commercial insurance will still be primary until 180 work quarters have been covered.
There are assistance programs like the American Kidney Fund that help pay insurance premiums for
ESRD patients and assist with other financial measures. The American Kidney Fund fights kidney disease
on all fronts as the nation's leading kidney nonprofit. AKF works on behalf of the 37 million Americans
living with kidney disease, and the millions more at risk, with an unmatched scope of programs that
support people wherever they are in their fight against kidney disease — from prevention through post-
transplant living (American Kidney Fund, 2022).
It will be difficult, if not impossible, to deliver patient-centered care without taking time to listen to our
patients
and build relationships with them. Upholding who they are will sometimes challenge us to move
beyond our narrow role as specialists and re-imagine what constitutes good care. Putting these practices
to work in the complex, fragmented, technologically focused health care environments in which many of
us operate will not be easy, but in my opinion has real potential to improve the experiences of patients and
providers (O’hare, 2018). The IDT team plays a big role in timely and patient centered cared too.
Challenges : transportation, work/life schedule
References:
Institute for Healthcare Improvement (IHI). (2019a). Across the chasm: Six aims for changing the health
care system. Retrieved from
http://www.ihi.org/resources/Pages/ImprovementStories/AcrosstheChasmSixAimsforChangingth
eHealthCareSystem.aspx
Join us in fighting kidney disease on all fronts. American Kidney Fund. (2022, March 23). Retrieved
March 26, 2022, from https://www.kidneyfund.org/
Kansas Health Matters, K. H. (n.d.).
Chronic kidney disease: Medicare population
. Kansas. Retrieved
March 23, 2022, from
https://www.kansashealthmatters.org/indicators/index/view?
indicatorId=2056&localeId=19
Kidney disease and dialysis information
. DaVita. (n.d.). Retrieved March 26, 2022, from
https://www.davita.com/
O’Hare, A. M. (2018). Patient-centered care in renal medicine: Five strategies to meet the Challenge.
American Journal of Kidney Diseases, 71(5), 732–736. https://doi.org/10.1053/j.ajkd.2017.11.022
Shi, L., & Singh, D. A. (2019).
Delivering health care in America: A systems approach
(7th ed.).
Burlington, MA: Jones & Bartlett.
Describe
one
organization/agency that would be involved in care
delivery for your hypothetical patient. Provide specific details related
to:
o
Types of patients typically treated at this facility
o
Administration
o
Departments
o
Payment sources the organization accepts
o
Performance improvement efforts
Briefly identify other organizations/agencies with which your selected
organization is likely to coordinate in order to provide optimal care.
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