Journal
NEPHROLOGY
Volume 15, Issue 1, Pages 108-115Publisher
WILEY
DOI: 10.1111/j.1440-1797.2009.01154.x
Keywords
chronic kidney disease; chronic kidney disease care program; end-stage renal disease; haemodialysis (HD); medical costs; service utilization
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Funding
- Taiwan Society of Nephrology
- Bureau of Health Promotion, Department of Health, Taiwan [DOH92-HP-1121]
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Aim: Multidisciplinary care of patients with chronic kidney disease (CKD) provides better care outcomes. This study is to evaluate the effectiveness of a CKD care program on pre-end-stage renal disease (ESRD) care. Methods: One hundred and forty incident haemodialysis patients were classified into the CKD Care Group (n = 71) and the Nephrologist Care Group (n = 69) according to participation in the CKD care program before dialysis initiation. The 'total observation period' was divided into '6 months before dialysis' and 'at dialysis initiation'. Quality of pre-ESRD care, service utilization and medical costs were evaluated and compared between groups. Results: The mean estimated glomerular filtration rates at dialysis initiation were low in both groups; but the levels of haematocrit and serum albumin of the CKD Care Group were significantly higher. The percentages of patients initiating dialysis with created vascular access, without insertion of double-lumen catheter and without hospitalization were 57.7%, 50.7% and 40.8%, respectively, in the CKD Care Group, and 37.7%, 29.0% and 18.8% in the Nephrologist Care Group (P < 0.001). Participation in the CKD care program, though with higher costs during the 6 months before dialysis ($US1428 +/- 2049 vs US$675 +/- 962/patient, P < 0.001), was significantly associated with lower medical costs at dialysis initiation ($US942 +/- 1941 vs $US2410 +/- 2481/patient, P < 0.001) and for the total period of observation ($US2674 +/- 2780 vs $US3872 +/- 3270/patient, P = 0.009). The cost-saving effect came through the early preparation of vascular access and the lack of hospitalization at dialysis initiation. Conclusion: CKD care programs significantly improve quality of pre-ESRD care, decrease service utilization and save medical costs.
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