Premium
Multidisciplinary care improves clinical outcome and reduces medical costs for pre‐end‐stage renal disease in T aiwan
Author(s) -
Chen YueRen,
Yang Yu,
Wang ShuChuan,
Chou WenYu,
Chiu PingFang,
Lin ChingYuang,
Tsai WenChen,
Chang JerMing,
Chen TzenWen,
Ferng ShyangHwa,
Lin ChunLiang
Publication year - 2014
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12316
Subject(s) - medicine , dialysis , end stage renal disease , observational study , emergency medicine , peritoneal dialysis , kidney disease , disease , intensive care medicine , retrospective cohort study
Aim Multidisciplinary care ( MDC ) for patients with chronic kidney disease ( CKD ) may help to optimize disease care and improve clinical outcomes. Our study aimed to evaluate the effectiveness of pre‐end‐stage renal disease ( ESRD ) patients under MDC and usual care in T aiwan. Method In this 3‐year retrospective observational study, we recruited 822 ESRD subjects, aged 18 years and older, initiating maintenance dialysis more than 3 months from five cooperating hospitals. The MDC ( n = 391) group was cared for by a nephrologists‐based team and the usual care group ( n = 431) was cared for by sub‐specialists or nephrologists alone more than 90 days before dialysis initiation. Patient characteristics, dialysis modality, hospital utilization, hospitalization at dialysis initiation, mortality and medical cost were evaluated. Medical costs were further divided into in‐hospital, emergency services and outpatient visits. Results The MDC group had a better prevalence in peritoneal dialysis ( PD ) selection, less temporary catheter use, a lower hospitalization rate at dialysis initiation and 15% reduction in the risk of hospitalization ( P < 0.05). After adjusting for gender, age and C harlson C omorbidity I ndex score, there were lower in‐hospital and higher outpatient costs in the MDC group during 3 months before dialysis initiation ( P < 0.05). In contrast, medical costs ( NT $ 146 038 vs 79 022) and hospitalization days (22.4 vs 15.5 days) at dialysis initiation were higher in the usual care group. Estimated medical costs during 3 months before dialysis till dialysis initiation, the MDC group yielded a reduction of NT $ 59 251 for each patient ( P < 0.001). Patient mortality was not significantly different. Conclusion Multidisciplinary care intervention for pre‐ ESRD patients could not only significantly improve the quality of disease care and clinical outcome, but also reduce medical costs.