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Fragmentation of care as a barrier to optimal ESKD management
Author(s) -
Sloan Caroline E.,
Zhong Judy,
Mohottige Dinushika,
Hall Rasheeda,
Diamantidis Clarissa J.,
Boulware Leight E.,
Wang Virginia
Publication year - 2020
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12929
Subject(s) - medicine , psychological intervention , health care , specialty , context (archaeology) , healthcare delivery , continuum of care , kidney disease , epidemiology , fragmentation (computing) , intensive care medicine , end stage kidney disease , nursing , family medicine , economic growth , paleontology , computer science , economics , biology , operating system
Caring for patients with end‐stage kidney disease (ESKD) in the United States is challenging, due in part to the complex epidemiology of the disease's progression as well as the ways in which care is delivered. As CKD progresses toward ESKD, the number of comorbidities increases and care involves multiple healthcare providers from multiple subspecialties. This occurs in the context of a fragmented US healthcare delivery system that is traditionally siloed by provider specialty, organization, as well as systems of payment and administration. This article describes the role of care fragmentation in the delivery of optimal ESKD care and identifies research gaps in the evidence across the continuum of care. We then consider the impact of care fragmentation on ESKD care from the patient and health system perspectives and explore opportunities for system‐level interventions aimed at improving care for patients with ESKD.