TY - JOUR
T1 - Continuity of care
T2 - Evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study
AU - Chen, Yin Cheng
AU - Weng, Shuen Fu
AU - Hsu, Yu Juei
AU - Wei, Chung Jen
AU - Chiu, Chiung Hsuan
N1 - Funding Information:
The database this study used was supported by a project that corresponding author
Publisher Copyright:
© 2020 Author(s) (or their employer(s)).
PY - 2020/12/29
Y1 - 2020/12/29
N2 - Objectives To control and prevent the burdens associated with chronic kidney disease (CKD), Taiwan's National Health Insurance Administration (NHIA) launched the 'early-CKD programme' in 2011 to extend care and education to patients with CKD. This study aims to evaluate the effectiveness of the early-CKD programme in terms of continuity of care (COC). Design and participants This study used secondary data from 2010 to 2014 provided by the NHIA to identify 86 581 participants each for the intervention and control groups. Patients with CKD who participated in the early-CKD programme between 2011 and 2013 were defined as the intervention group. For the control group, propensity score matching was used to select patients with CKD who did not participate in the programme, but were seen by the same group of physicians. Intervention A multidisciplinary care model for patients with early CKD launched in 2011. Primary outcome measures Outcome variables included the continuity of care index (COCI), which measures a physician's COC; number of essential examinations; and resource utilisation. To better identify the difference between groups, we separated COCI into two groups based on mean: high (above mean) and low (below mean). A generalised estimating equation model was used to examine the effects of the early-CKD programme. Results The programme significantly increased the number of essential examinations/tests administered to patients (β=0.61, p<0.001) and improved COCI between physicians and patients (OR=4.18, p<0.001). Medical expenses (β=1.03, p<0.001) and medication expenses (β=0.23, p<0.001) significantly increased after the programme was implemented, but patients' kidney-related hospitalisations and emergency department visits decreased (β=-0.13, p<0.001). Conclusion From the COC viewpoint, the programme in Taiwan showed a positive effect on COCI, number of essential examinations and resource utilisation.
AB - Objectives To control and prevent the burdens associated with chronic kidney disease (CKD), Taiwan's National Health Insurance Administration (NHIA) launched the 'early-CKD programme' in 2011 to extend care and education to patients with CKD. This study aims to evaluate the effectiveness of the early-CKD programme in terms of continuity of care (COC). Design and participants This study used secondary data from 2010 to 2014 provided by the NHIA to identify 86 581 participants each for the intervention and control groups. Patients with CKD who participated in the early-CKD programme between 2011 and 2013 were defined as the intervention group. For the control group, propensity score matching was used to select patients with CKD who did not participate in the programme, but were seen by the same group of physicians. Intervention A multidisciplinary care model for patients with early CKD launched in 2011. Primary outcome measures Outcome variables included the continuity of care index (COCI), which measures a physician's COC; number of essential examinations; and resource utilisation. To better identify the difference between groups, we separated COCI into two groups based on mean: high (above mean) and low (below mean). A generalised estimating equation model was used to examine the effects of the early-CKD programme. Results The programme significantly increased the number of essential examinations/tests administered to patients (β=0.61, p<0.001) and improved COCI between physicians and patients (OR=4.18, p<0.001). Medical expenses (β=1.03, p<0.001) and medication expenses (β=0.23, p<0.001) significantly increased after the programme was implemented, but patients' kidney-related hospitalisations and emergency department visits decreased (β=-0.13, p<0.001). Conclusion From the COC viewpoint, the programme in Taiwan showed a positive effect on COCI, number of essential examinations and resource utilisation.
KW - chronic renal failure
KW - health policy
KW - nephrology
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U2 - 10.1136/bmjopen-2020-041149
DO - 10.1136/bmjopen-2020-041149
M3 - Article
C2 - 33376170
AN - SCOPUS:85098640643
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 12
M1 - e041149
ER -
