Faculty Research: Dale Lupu

What research are you working on now?

We test strategies for implementing supportive (palliative) care for people with kidney disease. We develop and test new care models and train providers in communication skills and primary palliative care best practices.

Why is this work important?

People with kidney failure have a very high symptom burden that is often unaddressed, and have a high 5 year mortality rate that is not acknowledged or planned for. Patients say that they want to discuss their goals and end of life concerns with their providers, but providers lack skills and confidence to do so. Further, the current kidney care delivery models focus on the health of the organ rather than the well-being of the patient. Transforming the culture of care to be more person-centered will improve quality of life for patients and their families and relieve moral distress of providers.

What are the potential policy implications of your work?

Our work uncovers specific policy barriers that impede changing models of care. For instance, current Medicare payment structures inhibit hospices and dialysis providers working together to deliver concurrent hospice and dialysis as people transition to hospice at the end of life. Similarly, Medicare quality measurement requirements currently deter flexible, patient-centered dialysis schedules that depart from the standard 3 time per week prescription.  We have successfully advocated with CMS to address these concerns within new value-based payment models currently being tested by the Centers for Medicare & Medicaid Innovation (CMMI).