Improved nursing home end‐stage renal disease patient participation in physical therapy with onsite, more frequent dialysis

Abstract

AbstractIntroductionFor end‐stage renal disease (ESRD) patients residing in skilled nursing facilities (SNFs), the logistics and physical exhaustion of life‐saving hemodialysis therapy often conflict with rehabilitation goals. Integration of dialysis care with rehabilitation programs in a scalable and cost‐efficient manner has been a significant challenge. SNF‐resident ESRD patients receiving onsite, more frequent hemodialysis (MFD) have reported rapid post‐dialysis recovery. We examined whether such patients have improved Physical Therapy (PT) participation.MethodsWe conducted a retrospective electronic medical records review of SNF‐resident PT participation rates within a multistate provider of SNF rehabilitation care from January 1, 2022 to June 1, 2022. We compared three groups: ESRD patients receiving onsite MFD (Onsite‐MFD), ESRD patients receiving offsite, conventional 3×/week dialysis (Offsite‐Conventional‐HD), and the general non‐ESRD SNF rehabilitation population (Non‐ESRD). We evaluated physical therapy participation rates based on a predefined metric of missed or shortened (<15 min) therapy days. Baseline demographics and functional status were assessed.FindingsNinety‐two Onsite‐MFD had 2084 PT sessions scheduled, 12,916 Non‐ESRD had 225,496 PT sessions scheduled, and 562 Offsite‐Conventional‐HD had 9082 PT sessions scheduled. In mixed model logistic regression, Onsite‐MFD achieved higher PT participation rates than Offsite‐Conventional‐HD (odds ratio: 1.8, CI: 1.1–3.0; p < 0.03), and Onsite‐MFD achieved equivalent PT participation rates to Non‐ESRD (odds ratio: 1.2, CI: 0.3–1.9; p < 0.46). Baseline mean ± SD Charlson Comorbidity score was significantly higher in Onsite‐MFD (4.9 ± 2.0) and Offsite‐Conventional‐HD (4.9 ± 1.8) versus Non‐ESRD (2.6 ± 2.0; p < 0.001). Baseline mean self‐care and mobility scores were significantly lower in Onsite‐MFD versus Non‐ESRD or Offsite‐Conventional‐HD.DiscussionSNF‐resident ESRD patients receiving MFD colocated with rehabilitation had higher PT participation rates than those conventionally dialyzed offsite and equivalent PT participation rates to the non‐ESRD SNF‐rehabilitation general population, despite being sicker, less independent, and less mobile. We report a scalable program integrating dialysis and rehabilitation care as a potential solution for ESRD patients recovering from acute hospitalization.