EHRs can help ID timing, reasons for dialysis initiation

The data in electronic health records can help pinpoint when and why dialysis was initiated for chronic kidney disease, and thereby perhaps make the decision more patient-oriented, according to a recent study in JAMA Internal Medicine.

The researchers, from the University of Washington Department of Medicine and elsewhere, noted that there is often uncertainty about the best time for a patient to begin maintenance dialysis and little evidence to guide the decision. They conducted a national random sample of 1,691 patients from the Department of Veterans Affairs for whom the decision to initiate the dialysis occurred between Jan. 1, 2000, and Dec. 31, 2009. The data analysis took place in 2014.

They found that the EHR records worked better than mere patient or physician interviews or other methods to review decisions about dialysis, particularly in capturing decisions about treatment at the time they occurred. Three factors influenced the timing of dialysis initiation: physician practices, such as the use of medical interventions to forestall the initiation; sources of momentum, including a patient's acute illness or status as a hospital inpatient; and physician/patient dynamics, such as resistance on the part of the patient and paternalism on the part of the doctor.

While physicians took a more safety conscious approach to dialysis, many patients emphasized quality of life and autonomy, seeing dialysis as a "last resort." The data revealed that in a real world clinical setting there were "substantial" challenges to shared treatment decision making integrating patients' wishes with physician experience regarding prognosis and risk/benefits of dialysis.

The researchers recommended that decisions regarding the initiating of dialysis be more patient-centered.

"[O]ur findings call for stronger efforts to improve patient-physician communication with a view to clarifying patients' healthcare values, goals, and preferences and better aligning treatment recommendations with patients' priorities," they said. "Our findings also suggest that there is work to be done to better understand how to best support patients' readiness to face serious illness and engage in treatment decisions about initiation of dialysis."

Other studies have found EHRs to be helpful in not only in individual patient care, but also in culling information to benefit patient health. For example, EHRs can identify patients at high risk of cancer and those not filling their prescriptions.

To learn more:
- here's the study abstract