Study on Licensed & Unlicensed Dialysis Technicians

The prevalence of patients with End Stage Renal Disease (ESRD) has increased and efforts to control cost and meet managed care demands for lower reimbursements, have resulted in the increased use of unlicensed personnel in dialysis treatment centers. There is considerable evidence that the need to reduce costs is having adverse effects on ESRD patient outcomes; tendencies toward unlicensed personnel usage and decreased treatment duration have resulted in increased mortality. Although these effects are reported, studies have failed to examine the effects on patient outcomes with regard to the competence and confidence levels of licensed and unlicensed providers of dialysis treatment to ESRD patients. Moreover, few if any investigators have attempted to empirically establish that there are true differences in skill between the two groups. This study will examine those issues.

Chronic Renal Failure is a progressive, irreversible loss of renal function that occurs over varying periods of time ranging from a few months to decades (Parker, 1998). At the end of 1997 there were 304,083 patients being treated for ESRD. During that year, 79,102 new patients started ESRD treatment. At the end of 1997, over 307,00 patients were receiving treatment for ESRD (point prevalence) while over 360,000 patients received ESRD treatment some time during 1997 (period prevalence includes ESRD patients who died in 1997) (Parker). In order to meet the demand for l

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echnicians trained only to perform the dialysis procedures lowers the level of clinical training and skill of the personnel who deal directly with patients (Cahn & Pauley, 1990; Garcia & Held, 1990; Josefson, 1999; Nissenson & Rettig, 1999). Held (1990) argues that the high cost of RNs is exacerbated by the reduced reimbursement provided by Medicare. Therefore, the staffing of dialysis units is a reaction to the Medicare price for dialysis. Data strongly suggest that decreased reimbursement has led to decreased staffing in dialysis units and to reductions in the number of nurses, social workers, and dietitians. Professional opinion is that these changes are adverse to the quality of care (Levinsky & Rittig, 1991). Studies have shown that attempts to cut costs of ESRD treatment have resulted in the increased usage of unlicensed personnel. This change has resulted in negative consequences for the patient. The Consequences of Too Few Licensed Personnel The two reported consequences of excessive reliance on unlicensed personnel are negative patient outcomes and reduced dialysis treatment duration, and both occur because of cost pressures on dialysis clinics. Outcome management focuses on using outcome measures to manag

Category: Medical - S