Multidisciplinary care improves clinical outcome and reduces medical costs for pre-end-stage renal disease in Taiwan

作者：Chen Yue Ren; Yang Yu^*; Wang Shu Chuan; Chou Wen Yu; Chiu Ping Fang; Lin Ching Yuang; Tsai Wen Chen; Chang Jer Ming; Chen Tzen Wen; Ferng Shyang Hwa; Lin Chun Liang

来源：Nephrology, 2014, 19(11): 699-707.

DOI：10.1111/nep.12316

• chronic kidney disease
• hospitalization
• medical costs
• mortality
• multidisciplinary care

AimMultidisciplinary 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 Taiwan. %26lt;br%26gt;MethodIn 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. %26lt;br%26gt;ResultsThe 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%26lt;0.05). After adjusting for gender, age and Charlson Comorbidity Index score, there were lower in-hospital and higher outpatient costs in the MDC group during 3 months before dialysis initiation (P%26lt;0.05). In contrast, medical costs (NT$ 146038 vs 79022) 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$ 59251 for each patient (P%26lt;0.001). Patient mortality was not significantly different. %26lt;br%26gt;ConclusionMultidisciplinary care intervention for pre-ESRD patients could not only significantly improve the quality of disease care and clinical outcome, but also reduce medical costs. %26lt;br%26gt;Summary at a Glance This retrospective study clearly demonstrates that multidisciplinary care by nephrologists in dialysis patients provided better various outcomes and less medical costs. However, the patient mortality was not different.

• 出版日期2014-11
• 单位中国医科大学