Compared with the general Medicare population, patients with ESKD have worse quality metrics for end-of-life care, including a higher percentage experiencing hospitalizations and in-hospital deaths and a lower percentage referred to hospice. We developed a Concurrent Hospice and Dialysis Program in which patients may receive palliative dialysis alongside hospice services. The Program aims to improve access to quality end-of-life care and, ultimately, improve the experiences of patients, caregivers, and clinicians.

We sought to describe (1) the Program and (2) enrollment and utilization characteristics of Program participants.

We conducted a quantitative description of demographics, patient characteristics, and utilization of Program enrollees.

Of 43 total enrollees, 44% received at least one dialysis treatment, whereas 56% received no dialysis. The median (range) hospice length of stay was 9 (1–76) days for all participants and 13 (4–76) days for those who received at least one dialysis treatment. The average number of dialysis treatments was 3.5 (range 1–9) for hemodialysis and 19.2 (range 3–65) for peritoneal dialysis. Sixty-five percent of enrollees died at home, 23% in inpatient hospice, and 12% in a nursing facility; no patients died in the hospital.

Our 3-year experience with the Program demonstrated that enrollees had a longer median hospice stay than the previously reported 5-day median for patients with ESKD. Most patients received no further dialysis treatments despite the option to continue dialysis. Our experience provides evidence to support future work testing the effectiveness of such clinical programs to improve patient and utilization outcomes.

与一般医疗保险人群相比，ESKD 患者临终关怀的质量指标较差，包括住院和院内死亡的比例较高，转诊至临终关怀的比例较低。我们制定了一项并行临终关怀和透析计划，其中患者可以在接受临终关怀服务的同时接受姑息性透析。该计划旨在改善获得优质临终护理的机会，并最终改善患者、护理人员和临床医生的体验。

我们试图描述 ( 1 ) 该计划和 ( 2 ) 计划参与者的注册和利用特征。

我们对计划参与者的人口统计、患者特征和利用情况进行了定量描述。

在 43 名参与者中，44% 的人至少接受过一次透析治疗，而 56% 的人未接受透析。所有参与者的临终关怀住院时间中位数（范围）为 9（1-76）天，而接受至少一次透析治疗的参与者则为 13（4-76）天。血液透析的平均透析治疗次数为 3.5 次（范围 1-9），腹膜透析的平均透析治疗次数为 19.2 次（范围 3-65）。 65% 的参与者在家中死亡，23% 在住院临终关怀中心死亡，12% 在护理机构死亡；没有患者在医院死亡。

我们 3 年的计划经验表明，参与者的临终关怀住院时间中位数比之前报道的 ESKD 患者的 5 天中位数更长。尽管可以选择继续透析，但大多数患者没有接受进一步的透析治疗。我们的经验为支持未来测试此类临床项目有效性的工作提供了证据，以改善患者和利用结果。