Models for Operationalizing Supportive Care in Kidney Care

The field of kidney supportive care is in a period of innovation, with different models emerging from local efforts to improve care. We classify emerging models into six types: embedded, mobile/visiting, chronic kidney disease case management, medical management without dialysis, concurrent hospice/dialysis, and comprehensive regional or system-wide programs. Although individual programs have demonstrated positive impact on outcomes such as advance care planning and place of death, there is not yet systematic evidence comparing the impact of model type on effectiveness or cost effectiveness. Local considerations about need, resources, opportunities, and champions are key to planning a supportive kidney care strategy. Facilitators for program success include training for nephrology providers, active collaboration between nephrology and palliative care, local champions (often nurses), sensitive messaging about medical management without dialysis, and research to demonstrate program impact.