Electronic medical records training in seattle

The transplant coordinator at our medical center receives referrals for veterans with advanced kidney disease from providers practicing both within and outside the Veterans Affairs Health Care System (VA). We conducted a thematic analysis of documentation in the electronic medical records of patients referred to the kidney transplant coordinator at the Veterans Affairs Puget Sound Health Care System (VAPSHCS) in Seattle, WA over a ten-year period who had not received a kidney by the end of follow-up. In order to gain insight into potential unintended consequences of policies to increase transplant referral, we conducted a qualitative analysis of the electronic medical records of patients who were evaluated for kidney transplant but did not receive a kidney. The medical and psychosocial evaluation process required for kidney transplant can be extensive, and may entail multiple clinic visits with specialists, diagnostic tests (e.g., cancer screening, cardiac angiography), and behavior modification (e.g., stopping tobacco use, improving diet).

Given the relatively limited supply of donor kidneys, policies intended to promote more widespread and equitable access to kidney transplant may have the unintended effect of increasing the number of patients who undergo evaluation for kidney transplant but do not ultimately receive a kidney. Increasing access to kidney transplant among patients with advanced kidney disease is also a central objective of the recent presidential Executive Order on Advancing American Kidney Health. Other national and regional initiatives focus on educating patients with advanced kidney disease about the option of kidney transplant and encouraging living kidney donation. The Centers for Medicare and Medicaid Services (CMS) requires that patients on dialysis be educated about transplant as a treatment option and has incorporated dialysis facility transplant rates into some quality metrics. In order to increase access to kidney transplant and promote more equitable organ allocation, a number of nationwide initiatives are currently underway to encourage transplant referrals. Kidney transplant is the preferred treatment for many patients with advanced kidney disease, but the limited availability of donor organs means that not all patients who might benefit can receive a kidney. Policies to promote referral for kidney transplant should be coupled with efforts to strengthen shared decision-making to ensure that the decision to undergo transplant evaluation is framed as an explicit choice with benefits, risks, and alternatives and patients have an opportunity to shape their involvement in this process. ConclusionsД®ngagement in the kidney transplant evaluation process can be a significant undertaking for patients and families and may impact many other aspects of their care. Three dominant themes emerged from qualitative analysis of documentation in the medical records of these patients: 1) Forward momentum: patients found themselves engaged in an iterative process of testing and treatment that tended to move forward unless an absolute contraindication to transplant was identified or patients disengaged 2) Potential for transplant shapes other medical decisions: engagement in the transplant evaluation process could impact many other aspects of patientsвЂ™ care and 3) Personal responsibility and psychological burden for patients and families: clinician documentation suggested that patients felt personally responsible for the course of their evaluation and that the process could take an emotional toll on them and theirВ family members. ResultsДЎ48 of 209 patients referred to the local kidney transplant coordinator at our center (71%) had not received a kidney by the end of follow-up. We performed a thematic analysis of clinician documentation in the electronic medical records of all adults at a single medical center with advanced kidney disease who were referred to the local transplant coordinator for evaluation between 20 but did not receive a kidney. Little is known about the potential implications of this experience for patients.

A potential pitfall of policies intended to promote referral for kidney transplant is that greater numbers of patients may be evaluated for transplant without experiencing the intended benefit of receiving a kidney.

Electronic medical records training in seattle