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Multidisciplinary predialysis education reduced the inpatient and total medical costs of the first 6 months of dialysis in incident hemodialysis patients.

Yu YJ, Wu IW, Huang CY, Hsu KH, Lee CC, Sun CY, Hsu HJ, Wu MS - PLoS ONE (2014)

Bottom Line: The mean age of study patients was 63.8±13.2 years, and 221 (49.7%) of them were men.The mean serum creatinine level and estimated glomerular filtration rate was 6.1±4.0 mg/dL and 7.6±2.9 mL⋅min(-1)⋅1.73 m(-2), respectively, at dialysis initiation.Participation of multidisciplinary education in pre-dialysis period was independently associated with reduction in the inpatient and total medical expenditures of the first 6 months post-dialysis owing to decreased inpatient service utilization secondary to cardiovascular causes and vascular access-related surgeries.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.

ABSTRACT

Background: The multidisciplinary pre-dialysis education (MPE) retards renal progression, reduce incidence of dialysis and mortality of CKD patients. However, the financial benefit of this intervention on patients starting hemodialysis has not yet been evaluated in prospective and randomized trial.

Methods: We studied the medical expenditure and utilization incurred in the first 6 months of dialysis initiation in 425 incident hemodialysis patients who were randomized into MPE and non-MPE groups before reaching end-stage renal disease. The content of the MPE was standardized in accordance with the National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines.

Results: The mean age of study patients was 63.8±13.2 years, and 221 (49.7%) of them were men. The mean serum creatinine level and estimated glomerular filtration rate was 6.1±4.0 mg/dL and 7.6±2.9 mL⋅min(-1)⋅1.73 m(-2), respectively, at dialysis initiation. MPE patients tended to have lower total medical cost in the first 6 months after hemodialysis initiation (9147.6±0.1 USD/patient vs. 11190.6±0.1 USD/patient, p = 0.003), fewer in numbers [0 (1) vs. 1 (2), p<0.001] and length of hospitalization [0 (15) vs. 8 (27) days, p<0.001], and also lower inpatient cost [0 (2617.4) vs. 1559,4 (5019.6) USD/patient, p<0.001] than non-MPE patients, principally owing to reduced cardiovascular hospitalization and vascular access-related surgeries. The decreased inpatient and total medical cost associated with MPE were independent of patients' demographic characteristics, concomitant disease, baseline biochemistry and use of double-lumen catheter at initiation of hemodialysis.

Conclusions: Participation of multidisciplinary education in pre-dialysis period was independently associated with reduction in the inpatient and total medical expenditures of the first 6 months post-dialysis owing to decreased inpatient service utilization secondary to cardiovascular causes and vascular access-related surgeries.

Trial registration: ClinicalTrials.gov NCT00644046.

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Enrolment scheme and patient status. MPE: multidisciplinary predialysis education.
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pone-0112820-g001: Enrolment scheme and patient status. MPE: multidisciplinary predialysis education.

Mentions: Patient cohort and settings The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1 and Protocol S1. This is an analysis of a subset population from our previously reported randomized cohort (Clinical Trials.gov NCT00644046) [16]. Briefly, the cohort includes predialysis CKD patients with an estimated glomerular filtration rate (eGFR) of <60 mL⋅min−1⋅1.73 m−2 (determined by using the Modification of Diet in Renal Disease equation) who visited the nephrology outpatient clinics of the Department of Nephrology, Chang Gung Memorial Hospital, Keelung, from July 2007 and followed up to June 30, 2011. Patients aged 18–80 years and without renal graft failure were included in the study after obtaining informed consent from them. A total of 2280 patients were enrolled in the study and were randomly divided into the MPE group and the non-MPE group by using a random table at study entry. Four hundred and five patients reached ESRD needing hemodialysis after a mean follow-up of 33±2.6 months (232 patients in the MPE group and 213 patients in the non-MPE group, as shown in Figure 1). The medical expenditure and utilization in the first 6 months of initiation of hemodialysis in these 425 patients were accurately recorded and compared between MPE and non-MPE patients. Medical service utilization was calculated as the frequency of outpatient visits and the frequency and length of hospitalization. Outpatient visits were categorized as outpatient services, preventive care (e.g., influenza vaccination and dietary counseling), and emergency services. Medical service expenditures included outpatient expenditures (all costs including physicians' and nursing fees, examinations, surgery, and medication) and inpatient expenditures (all costs including laboratory testing, imaging testing, medications, surgery and consulting, ward and administrative, nasogastric tube feeding, and hemodialysis fees). The expenditures for each participant were totaled to compute the sum of ambulatory and inpatient medical service utilization costs and expenditures. The analysis of costs in this study only included those medical costs for which our hospitals made reimbursement claims to the NHI. The salaries, overheads, and administrative costs of the care team were not included. This study was approved by the ethics committee of the institutional review board of Chang Gung Memorial Hospital (Number: 100-0040A3, 96-0408B) and was conducted according to the principles expressed in the Declaration of Helsinki. All patients provided written informed consent. The registration of our cohort at Clinical Trials.gov was delayed by administrative issues (set up of Core Lab, employment of research assistance). The authors confirm that all ongoing and related trials for this drug/intervention were registered.


Multidisciplinary predialysis education reduced the inpatient and total medical costs of the first 6 months of dialysis in incident hemodialysis patients.

Yu YJ, Wu IW, Huang CY, Hsu KH, Lee CC, Sun CY, Hsu HJ, Wu MS - PLoS ONE (2014)

Enrolment scheme and patient status. MPE: multidisciplinary predialysis education.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232513&req=5

pone-0112820-g001: Enrolment scheme and patient status. MPE: multidisciplinary predialysis education.
Mentions: Patient cohort and settings The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1 and Protocol S1. This is an analysis of a subset population from our previously reported randomized cohort (Clinical Trials.gov NCT00644046) [16]. Briefly, the cohort includes predialysis CKD patients with an estimated glomerular filtration rate (eGFR) of <60 mL⋅min−1⋅1.73 m−2 (determined by using the Modification of Diet in Renal Disease equation) who visited the nephrology outpatient clinics of the Department of Nephrology, Chang Gung Memorial Hospital, Keelung, from July 2007 and followed up to June 30, 2011. Patients aged 18–80 years and without renal graft failure were included in the study after obtaining informed consent from them. A total of 2280 patients were enrolled in the study and were randomly divided into the MPE group and the non-MPE group by using a random table at study entry. Four hundred and five patients reached ESRD needing hemodialysis after a mean follow-up of 33±2.6 months (232 patients in the MPE group and 213 patients in the non-MPE group, as shown in Figure 1). The medical expenditure and utilization in the first 6 months of initiation of hemodialysis in these 425 patients were accurately recorded and compared between MPE and non-MPE patients. Medical service utilization was calculated as the frequency of outpatient visits and the frequency and length of hospitalization. Outpatient visits were categorized as outpatient services, preventive care (e.g., influenza vaccination and dietary counseling), and emergency services. Medical service expenditures included outpatient expenditures (all costs including physicians' and nursing fees, examinations, surgery, and medication) and inpatient expenditures (all costs including laboratory testing, imaging testing, medications, surgery and consulting, ward and administrative, nasogastric tube feeding, and hemodialysis fees). The expenditures for each participant were totaled to compute the sum of ambulatory and inpatient medical service utilization costs and expenditures. The analysis of costs in this study only included those medical costs for which our hospitals made reimbursement claims to the NHI. The salaries, overheads, and administrative costs of the care team were not included. This study was approved by the ethics committee of the institutional review board of Chang Gung Memorial Hospital (Number: 100-0040A3, 96-0408B) and was conducted according to the principles expressed in the Declaration of Helsinki. All patients provided written informed consent. The registration of our cohort at Clinical Trials.gov was delayed by administrative issues (set up of Core Lab, employment of research assistance). The authors confirm that all ongoing and related trials for this drug/intervention were registered.

Bottom Line: The mean age of study patients was 63.8±13.2 years, and 221 (49.7%) of them were men.The mean serum creatinine level and estimated glomerular filtration rate was 6.1±4.0 mg/dL and 7.6±2.9 mL⋅min(-1)⋅1.73 m(-2), respectively, at dialysis initiation.Participation of multidisciplinary education in pre-dialysis period was independently associated with reduction in the inpatient and total medical expenditures of the first 6 months post-dialysis owing to decreased inpatient service utilization secondary to cardiovascular causes and vascular access-related surgeries.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.

ABSTRACT

Background: The multidisciplinary pre-dialysis education (MPE) retards renal progression, reduce incidence of dialysis and mortality of CKD patients. However, the financial benefit of this intervention on patients starting hemodialysis has not yet been evaluated in prospective and randomized trial.

Methods: We studied the medical expenditure and utilization incurred in the first 6 months of dialysis initiation in 425 incident hemodialysis patients who were randomized into MPE and non-MPE groups before reaching end-stage renal disease. The content of the MPE was standardized in accordance with the National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines.

Results: The mean age of study patients was 63.8±13.2 years, and 221 (49.7%) of them were men. The mean serum creatinine level and estimated glomerular filtration rate was 6.1±4.0 mg/dL and 7.6±2.9 mL⋅min(-1)⋅1.73 m(-2), respectively, at dialysis initiation. MPE patients tended to have lower total medical cost in the first 6 months after hemodialysis initiation (9147.6±0.1 USD/patient vs. 11190.6±0.1 USD/patient, p = 0.003), fewer in numbers [0 (1) vs. 1 (2), p<0.001] and length of hospitalization [0 (15) vs. 8 (27) days, p<0.001], and also lower inpatient cost [0 (2617.4) vs. 1559,4 (5019.6) USD/patient, p<0.001] than non-MPE patients, principally owing to reduced cardiovascular hospitalization and vascular access-related surgeries. The decreased inpatient and total medical cost associated with MPE were independent of patients' demographic characteristics, concomitant disease, baseline biochemistry and use of double-lumen catheter at initiation of hemodialysis.

Conclusions: Participation of multidisciplinary education in pre-dialysis period was independently associated with reduction in the inpatient and total medical expenditures of the first 6 months post-dialysis owing to decreased inpatient service utilization secondary to cardiovascular causes and vascular access-related surgeries.

Trial registration: ClinicalTrials.gov NCT00644046.

Show MeSH
Related in: MedlinePlus