{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:30:37Z","timestamp":1786480237368,"version":"build-2736575974"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["178157"],"award-info":[{"award-number":["178157"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","award":["178157"],"award-info":[{"award-number":["178157"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n People with kidney failure perceive disruptions in continuity of care before, during, and after their emergency care encounters.<\/jats:p>\n <\/jats:list-item>\n \n Patients report taking steps themselves to bridge gaps in continuity and ensure consistent informational flow across care teams.<\/jats:p>\n <\/jats:list-item>\n \n Strategies tailored to the unique emergency care needs of people with kidney failure may help strengthen continuity of care in this context.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n People with kidney failure have complex care needs and frequently access care using the emergency department (ED). Little is known about how continuity of care (CoC) relates to ED care seeking for people with kidney failure. To understand the experiences of CoC among adults with kidney failure in relation to their recent ED encounter.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Using a qualitative descriptive methodology, we purposively sampled adults with kidney failure (defined as eGFR <15 ml\/min per 1.73 m\n 2<\/jats:sup>\n and\/or receipt of maintenance dialysis) from Alberta who accessed the ED for a non\u2013life-threatening indication within the preceding 6 weeks between May 2024 and January 2025. We conducted individual semistructured interviews and analyzed transcripts in duplicate using a framework analysis approach with reference to an established framework defining CoC according to three types (\n i.e<\/jats:italic>\n ., relational, management, and informational). Thematic development involved both inductive and deductive techniques.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty-nine patients were included (12 in-center hemodialysis, one in-center nocturnal hemodialysis, seven peritoneal dialysis, five home hemodialysis, and four without KRT). Themes were identified within CoC types and across settings of before, during, and after the acute care encounter. Key relational continuity themes included stability and trust in care teams, disrupted therapeutic relationships, and re-establishing engagement in circles of care. Management continuity themes included safeguarding kidney supports and kidney care fragmentation in the ED. Informational continuity themes included patients as continuity self-advocates, bridging care through information sharing, and extending continuity beyond the ED.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Patients with kidney failure expressed varied experiences of CoC and identified important gaps relevant to the emergency care context. Strategies that bridge these perceived gaps across outpatient and acute care settings may help to mitigate the burden of ED use in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000001161","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T16:02:05Z","timestamp":1773072125000},"page":"1563-1572","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Continuity of Care Surrounding Emergency Department Encounters for People with Kidney Failure in Alberta, Canada"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3272-806X","authenticated-orcid":false,"given":"Hana E.","family":"Kotani","sequence":"first","affiliation":[{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3109-6837","authenticated-orcid":false,"given":"Stephanie","family":"Thompson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1068-8673","authenticated-orcid":false,"given":"Tyrone G.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannan","family":"Love","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3958-7561","authenticated-orcid":false,"given":"Paul E.","family":"Ronksley","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2743-4290","authenticated-orcid":false,"given":"Andrew D.","family":"McRae","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2229-2054","authenticated-orcid":false,"given":"Fariba","family":"Aghajafari","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8484-8361","authenticated-orcid":false,"given":"Maoliosa","family":"Donald","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Corradetti","sequence":"additional","affiliation":[{"name":"Patient Advisor, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Verdin","sequence":"additional","affiliation":[{"name":"Patient Advisor, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4711-1440","authenticated-orcid":false,"given":"Jennifer M.","family":"MacRae","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5434-2917","authenticated-orcid":false,"given":"Meghan J.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"B1-20260731","doi-asserted-by":"crossref","first-page":"S100","DOI":"10.1046\/j.1523-1755.2000.07417.x","article-title":"Comorbidities and their impact on outcome in patients with end-stage renal disease","volume":"57","author":"Prichard","year":"2000","journal-title":"Kidney Int."},{"issue":"9836","key":"B2-20260731","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study","volume":"380","author":"Barnett","year":"2012","journal-title":"Lancet."},{"issue":"1","key":"B3-20260731","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/jorc.12140","article-title":"Self-management support for people with chronic kidney disease: patient 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A rapid review","volume":"22","author":"Nicolet","year":"2022","journal-title":"BMC Health Serv Res."},{"issue":"1","key":"B11-20260731","doi-asserted-by":"crossref","first-page":"4","DOI":"10.7812\/TPP\/14-107","article-title":"Financial implications of the continuity of primary care","volume":"19","author":"Hollander","year":"2015","journal-title":"Perm J."},{"issue":"1","key":"B13-20260731","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1186\/s12913-016-1852-1","article-title":"Individual predictors of frequent emergency department use: a scoping review","volume":"16","author":"Krieg","year":"2016","journal-title":"BMC Health Serv Res."},{"issue":"11","key":"B14-20260731","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.2215\/CJN.04690416","article-title":"Potentially preventable hospitalization among patients with CKD and high inpatient use","volume":"11","author":"Ronksley","year":"2016","journal-title":"Clin J Am Soc Nephrol."},{"issue":"3","key":"B15-20260731","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1370\/afm.2813","article-title":"Determining the association between continuity of primary care and acute care use in chronic kidney disease: a retrospective cohort study","volume":"20","author":"Chong","year":"2022","journal-title":"Ann Fam Med."},{"issue":"2","key":"B17-20260731","doi-asserted-by":"crossref","first-page":"201","DOI":"10.3122\/jabfm.2016.12.150309","article-title":"Improving continuity of care reduces emergency department visits by long-term care residents","volume":"29","author":"Marshall","year":"2016","journal-title":"J Am Board Fam Med."},{"issue":"4","key":"B18-20260731","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G","article-title":"Whatever happened to qualitative description?","volume":"23","author":"Sandelowski","year":"2000","journal-title":"Res Nurs Health."},{"issue":"1","key":"B19-20260731","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1471-2288-9-52","article-title":"Qualitative description \u2013 the poor cousin of health research?","volume":"9","author":"Neergaard","year":"2009","journal-title":"BMC Med Res Methodol."},{"issue":"6","key":"B21-20260731","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care."},{"issue":"1","key":"B22-20260731","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/intqhc\/mzr068","article-title":"What do we know about patients' perceptions of continuity of care? 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A review of continuity and related concepts","volume":"29","author":"Uijen","year":"2012","journal-title":"Fam Pract."},{"issue":"4","key":"B26-20260731","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1097\/00005650-197704000-00010","article-title":"A quantitative measure of continuity of care","volume":"15","author":"Bice","year":"1977","journal-title":"Med Care."},{"issue":"3","key":"B27-20260731","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1370\/afm.23","article-title":"Defining and measuring interpersonal continuity of care","volume":"1","author":"Saultz","year":"2003","journal-title":"Ann Fam Med."},{"issue":"2","key":"B28-20260731","doi-asserted-by":"crossref","first-page":"76","DOI":"10.22454\/FamMed.2023.913197","article-title":"Continuity of care: a primer for family medicine residencies","volume":"56","author":"Garrison","year":"2024","journal-title":"Fam Med."},{"issue":"7","key":"B29-20260731","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1007\/s11606-019-04975-y","article-title":"Primary care physicians\u2019 perceived barriers to nephrology referral and co-management of patients with CKD: a qualitative study","volume":"34","author":"Greer","year":"2019","journal-title":"J Gen Intern Med."},{"issue":"16","key":"B30-20260731","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1001\/jama.2009.517","article-title":"Continuity of outpatient and inpatient care by primary care physicians for hospitalized older adults","volume":"301","author":"Sharma","year":"2009","journal-title":"JAMA."},{"key":"B31-20260731","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.genhosppsych.2016.01.004","article-title":"Improving continuity of care for frequent users of emergency departments: service user and provider perspectives","volume":"40","author":"Poremski","year":"2016","journal-title":"Gen Hosp Psychiatry."},{"issue":"10S","key":"B32-20260731","doi-asserted-by":"crossref","DOI":"10.1681\/ASN.2024kpf8f1e9","article-title":"No rest for the wicked: the complexity of nephrology inpatients is increasing over time: FR-OR04","volume":"35","author":"Ghimire","year":"2024","journal-title":"J Am Soc Nephrol."},{"issue":"2","key":"B33-20260731","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1001\/jamainternmed.2023.7410","article-title":"Population-based trends in complexity of hospital inpatients","volume":"184","author":"Naik","year":"2024","journal-title":"JAMA Intern Med."},{"issue":"1","key":"B34-20260731","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12912-024-01812-4","article-title":"Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre","volume":"23","author":"Albert","year":"2024","journal-title":"BMC Nurs."},{"issue":"1","key":"B35-20260731","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/hdi.12677","article-title":"Prospective monitoring of after-hours nursing and technologist support calls to a regional Canadian home hemodialysis program","volume":"23","author":"Reintjes","year":"2019","journal-title":"Hemodial Int."},{"issue":"6","key":"B36-20260731","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1053\/j.ajkd.2020.04.006","article-title":"Outpatient interventions for managing acute complications of chronic diseases: a scoping review and implications for patients with CKD","volume":"76","author":"Elliott","year":"2020","journal-title":"Am J Kidney Dis."},{"issue":"2","key":"B37-20260731","doi-asserted-by":"crossref","first-page":"100391","DOI":"10.1016\/j.xkme.2021.09.007","article-title":"Emergency department utilization among maintenance hemodialysis patients: a systematic review","volume":"4","author":"Han","year":"2022","journal-title":"Kidney Med."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:59:29Z","timestamp":1786478369000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001161"}},"subtitle":["A Qualitative Study"],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000001161","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]},"assertion":[{"value":"2025-10-28","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-17","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}