Effectiveness of Dialysis Transition Unit to Improve Patients' Decision-Making and Self-Management Skills
Bibliographic record
Abstract
Background: Dialysis initiation is a stressful time for people living with kidney failure. As a quality improvement initiative, we created a dialysis transition unit (DTU) in Calgary, Alberta with the goal of providing person-focused dialysis care for patients starting hemodialysis. Objectives:To compare patient’s perception of participation in self-management and receipt of dialysis transition/chronic care counseling using PACIC-20, (Patient Assessment of Chronic Illness Care) between patients starting hemodialysis in the DTU and in a traditional facility-based HD unit (HDU). Methods: PACIC-20, anxiety (GAD-7) and depression (PHQ-9) scores were captured prospectively (June 1, 2021-June 30, 2022) on patients starting hemodialysis on the DTU and the HDU at dialysis initiation and two weeks later. Our primary outcome of interest was between-group differences in PACIC-20 scores at 2 weeks after dialysis initiation. Secondary outcomes included between-group differences in PACIC-20 subcategories and between-group differences for the change in patient-reported outcome measures of GAD-7 and PHQ-9 at 2 weeks. Results: A total of 26 DTU and 26 HDU participants completed data collection (mean age 62.6 ± 17.7 years; 42.3% females). The PACIC-20 scores at two weeks were similar (DTU 3.60 ± 0.6 and HDU 3.26 ± 0.95, P = 0.21). All PACIC-20 subcategories were similar between groups except for problem solving, which trended higher in DTU (4.09 ± 0.9 vs 3.39± 1.36, p=0.06). The subcategory, patient activation was associated with improved anxiety in DTU (p= 0.02) but not HDU (p= 0.35). The between-group difference was significant for PHQ-9 for DTU (p= 0.007) but non-significant for GAD-7 (p=0.05). Conclusion: While we did not find a significant difference in the overall patient perception of self management (PACIC-20) when transitioning to a specialized DTU (vs HDU), we did find improved problem-solving scores and lower depression scores for DTU. Further research on the role of a DTU to optimize patient care is needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".