Research profile | When it comes to patient care, timing is everything

In order to answer the question of how to help doctors and patients make better treatment decisions, Assistant Professor Steven Shechter is conducting research to help build evidence-based guidelines that have a positive impact on patient and cost outcomes.

While Shechter's broad focus is on decision making in the health care system, his true interest lies in helping health-related organizations optimize efficiency in order to reduce costs and improve the quality of life for patients.

“I want to assess the cost efficacy, and quality implications associated with decisions that are made on the timing and type of treatments that are administered to patients,” he says.

“For example, I am interested in the process involved in preparing kidney disease patients for dialysis and then uncovering areas where improvements can be made.”

Most patients with chronic kidney disease will need dialysis, which is a process that involves the removal of blood from the body, inserting it into a machine that removes waste, then reinserting it into the body. In preparation for dialysis many patients require the creation of an arteriovenous fistula, which connects an artery to a vein so the blood can be filtered through the dialysis machine.

Working with a PhD student and nephrologist (a doctor who specializes in kidney disease, transplants, and dialysis), Shechter is looking at the steps that are involved in forecasting when a patient may need dialysis and when to start preparing the fistula as a result. This assessment is critical given the time that is required for the fistula to mature. The preparation needs to be completed far enough in advance of the actual dialysis to ensure maximized efficacy of waste removal and minimized risk of complication for the patient.

In order to determine the optimal timing of the procedure, Shechter is undertaking an exhaustive review of the history of 1,000 patients. Using this data, he and his team are building simulation models that assess the pre-dialysis disease progression and outcomes associated with the procedure to determine the optimum time to start the process.

His work will have a major impact on patient care and recovery and the cost of maintaining a health care system.

“Timing is everything,” he says. “We can reduce health care costs and improve patient quality of life by understanding how the system works. This work will form the base upon which evidence-based guidelines will be developed for clinicians who treat patients with chronic kidney disease.”

Learn more about Assistant Professor Shechter and his latest research interests.