In February 2016, approximately 100,000 people in Germany were affected by chronic kidney disease. 80,000 people in a dialysis program and 20,000 in post-transplant care. The figures are based on projections of health insurance data.
95 % of the dialysis treatment is carried out in a dialysis facility 3 times a week for 4 to 5 hours. A suitable vessel access/shunt is necessary to carry it through. As a "lifeline" and at the same time "Achilles heel" it influences the quality of dialysis and thus also the quality of life of chronically ill people. The access of first choice is an arterio-venous fistula (AVF), which is punctured 375 times a year during 3 dialysis treatments per week 2 punctures per dialysis treatment in 52 weeks per year. Mispunctures and additional dialysis were not considered.
Aim: The work examines the benefits of ultrasound-guided shunt puncture from the point of view of cost units and service providers. The following questions are to be answered:
1. Provides the use of ultrasound-guided shunt puncture for payers and for the in-dividual dialysis unit a concrete monetary benefit?
2. Is the acceptance of the shunt punctures by the patients with the use of ultra-sound technique improved?
3. Is the use of ultrasound technology associated with an improvement in puncture quality and a longer shunt survival?
Results: There are only a few studies on the use of ultrasonic controlled shunt puncture. None of the users has yet investigated and documented their benefits in a structured manner. The more than 10 years of experience of the team of the slide analysis facility of the Ev. Stift Koblenz under the leadership of Doctor Morgenstern and Doctor Kurb could be used for this work. The greatest monetary benefit results for the cost objects. Outpatient care and radiolog-ical interventions without inpatient admissions represent considerable savings potential.
From the perspective of nephrologists in private practice, additional costs are initially incurred for the acquisition of ultrasound technology and the further training of nursing staff. The introduction of ultrasound-assisted shunt puncture requires organizational and personal adjustments, which must be supported and supported by the medical directors of the dialysis facilities.
Table of Contents
1. Introduction, Objective, Questions
1.1 Introduction
1.2 Objective
1.3 Research questions
2. Theoretical background
2.1 Definitions
2.1.1 Haemodialysis
2.1.2 Classification of vascular access
2.1.3 Ultrasound and doppler technology in medicine
2.1.4 Quality of life concept
2.2 Historical development and technology of doppler sound
2.2.1 Historical development
2.2.2 Technology of ultrasound
2.3 Empirical findings on ultrasound-guided venepuncture
3. Methodical approach
4. The use of ultrasound-guided shunt cannulation
5. Economic evaluation of different types of care
5.1 Costs and revenues in dialysis therapy
5.1.1 Costs of therapy from payer’s perspective
5.1.2 Costs of therapy from hospital perspective
5.1.3 Costs of therapy from dialysis centre perspective
5.1.4 Opportunity costs of dialysis centres
5.2 Revenue elements
5.2.1 Revenue of hospitals
5.2.2 Revenue of dialysis centres
5.3 Cost-benefit analysis
5.3.1 Cost-benefit analysis from payer’s perspective
5.3.2 Cost-benefit analysis from hospital perspective
5.3.3 Cost-benefit analysis from dialysis centre perspective
6. Expected outcome
6.1 Use of ultrasound technology for payer and service providers
6.1.1 Use of ultrasound technology from payer’s perspective
6.1.2 Use of ultrasound technology from hospital perspective
6.1.3 Use of ultrasound technology from dialysis centre perspective
6.2 Shunt cannulation, shunt survival and Quality of life
6.2.1 Cannulation quality and shunt survival
6.2.2 Quality of life
7. Summery and reference to research questions
7.1 Monetary benefit
7.2 Acceptance by patients
7.3 Cannulation quality and shunt survival
8. Critical view and further research needs
9. VI Bibliography
Objectives and Research Themes
The primary objective of this thesis is to evaluate the health economic impact of implementing ultrasound-guided shunt cannulation in dialysis therapy. The research examines whether this technology improves cannulation quality, prolongs shunt survival, and affects patient satisfaction and overall healthcare costs, specifically addressing the following research themes:
- Economic benefits of ultrasound-guided cannulation for payers and dialysis units.
- Improvement of patient acceptance through ultrasound-guided procedures.
- Correlation between the use of ultrasound technology and enhanced cannulation quality.
- Impact of the technology on the long-term survival rates of dialysis shunts.
- Requirements for personnel and training to master ultrasound-assisted techniques.
Excerpt from the Book
2.1.2 Classification of vascular access
Until 2009, there was a heterogeneous landscape in Germany about dialysis access in terms of the name, its plant and its significance for renal replacement therapy. On the initiative of the German Association for Clinical Nephrology, the boards of directors of various specialist associations joined forces in 2008 to form the GHIA. The guideline "Vascular access to haemodialysis" was developed from its interdisciplinary recommendations (cf. Hollenbeck; Mickley; Brunckwall et al., 2009).
This guideline is based on the "European Best Practice Guidelines on Vascular Access" (cf. Tordior; Canaud; Haage et al., 2007, p. ii88ff). Afterwards, haemodialysis accesses are classified as first to third choice accesses:
Access of the first choice: Creating a native AVF - The Radiocephalica (RC) AVF on the wrist is the first option. If matured adequately, it can be used for years with minimal complication rate, revisions and interventions. The long-term function rate is 65-90% after one year and 60-80% after two years, with a simultaneous low incidence rate of thrombosis (0.2 events per patient per year) and infections (2%). One disadvantage is the rate of early occlusion of 5 - 30 % (cf. Hollenbeck; Mick-ley; Brunkwall et al., 2009, p. 161).
Summary of Chapters
1. Introduction, Objective, Questions: This chapter introduces the context of chronic kidney disease in Germany, defines the necessity of reliable vascular access, and outlines the research objectives and guiding questions of the thesis.
2. Theoretical background: This section provides definitions of key medical terms like haemodialysis and quality of life, alongside an overview of ultrasound technology and empirical literature on venepuncture.
3. Methodical approach: This chapter details the research methodology, focusing on a structured literature analysis across various medical databases to identify studies related to ultrasound-guided shunt puncture.
4. The use of ultrasound-guided shunt cannulation: This section summarizes current global and local state-of-knowledge regarding the practical application of ultrasound-guided shunt puncture in dialysis centers.
5. Economic evaluation of different types of care: This chapter analyzes the costs and revenues associated with dialysis therapy from the perspectives of payers, hospitals, and dialysis centers, including a comparative cost-benefit analysis.
6. Expected outcome: This chapter examines the anticipated benefits of ultrasound-guided cannulation concerning cost reduction, puncture quality, shunt survival, and the impact on patients' quality of life.
7. Summery and reference to research questions: This section synthesizes the findings and provides direct answers to the research questions established at the beginning of the thesis.
8. Critical view and further research needs: This final chapter critically evaluates the data limitations and suggests future research directions, such as the establishment of a dialysis register.
Keywords
Haemodialysis, Ultrasound-guided cannulation, Vascular access, Arteriovenous fistula (AVF), Shunt survival, Cost-benefit analysis, Nephrology, Patient satisfaction, Dialysis quality, Health economics, Puncture technique, Renal replacement therapy, Medical technology, Healthcare costs, Nursing competence.
Frequently Asked Questions
What is the core subject of this thesis?
The thesis investigates the implementation of ultrasound-guided shunt cannulation in dialysis therapy, analyzing its impact from both a clinical and health economic perspective.
Which areas are central to this research?
The central themes include cost-benefit analysis of dialysis care, the technological requirements for ultrasound-guided puncture, the impact on shunt survival, and the role of specialized nursing staff.
What is the primary objective?
The objective is to determine if ultrasound-guided cannulation offers monetary benefits to payers and dialysis units and if it improves clinical outcomes such as cannulation quality and shunt longevity.
Which scientific methodology is applied?
The work employs a structured literature analysis combined with an economic cost-benefit evaluation based on data from German healthcare billing systems (DRG, EBM).
What topics are discussed in the main body?
The main body covers the classification of vascular access, the physics of ultrasound, empirical findings on venepuncture, and a detailed breakdown of costs and revenues for hospitals and dialysis centers.
Which keywords define this work?
Key terms include haemodialysis, ultrasound-guided cannulation, vascular access, AVF, shunt survival, cost-benefit analysis, nephrology, and dialysis quality.
How do inpatient and outpatient costs compare in this study?
The study highlights significant cost differences, illustrating that inpatient hospital stays due to shunt complications are substantially more expensive than standard outpatient dialysis.
What role does the nursing staff play in ultrasound-guided cannulation?
Nursing staff are identified as the primary users of this technology, requiring specialized theoretical and practical training to ensure high-quality puncture and long-term shunt maintenance.
What does the author conclude about the monetary benefit for dialysis centers?
The author notes that while there are initial costs for equipment and training, the long-term benefits of avoiding shunt failure and inpatient admissions contribute to securing future revenue and better dialysis outcomes.
What specific data limitation is mentioned regarding the research?
A significant limitation is the lack of centralized data and comprehensive "secrecy" regarding exact patient figures and specific shunt complication rates, which necessitates the use of extrapolated models and case assumptions.
- Citar trabajo
- Angela Drähne (Autor), 2017, Ultrasound-guided Cannulation. A Health Economic Consideration, Múnich, GRIN Verlag, https://www.grin.com/document/436426
