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

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

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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 Taiwan. 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 Charlson Comorbidity Index 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.

Original languageEnglish
Pages (from-to)699-707
Number of pages9
JournalNephrology
Volume19
Issue number11
DOIs
Publication statusPublished - Nov 1 2014

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Taiwan
Chronic Kidney Failure
Dialysis
Costs and Cost Analysis
Hospitalization
Outpatients
Mortality
Quality of Health Care
Peritoneal Dialysis
Risk Reduction Behavior
Chronic Renal Insufficiency
Observational Studies
Hospital Emergency Service
Comorbidity
Patient Care
Catheters
Retrospective Studies
Maintenance

Keywords

  • Chronic kidney disease
  • Hospitalization
  • Medical costs
  • Mortality
  • Multidisciplinary care

ASJC Scopus subject areas

  • Nephrology

Cite this

Chen, Y. R., Yang, Y., Wang, S. C., Chou, W. Y., Chiu, P. F., Lin, C. Y., ... Lin, C. L. (2014). Multidisciplinary care improves clinical outcome and reduces medical costs for pre-end-stage renal disease in Taiwan. Nephrology, 19(11), 699-707. https://doi.org/10.1111/nep.12316

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

In: Nephrology, Vol. 19, No. 11, 01.11.2014, p. 699-707.

Research output: Contribution to journalArticle

Chen, YR, Yang, Y, Wang, SC, Chou, WY, Chiu, PF, Lin, CY, Tsai, WC, Chang, JM, Chen, TW, Ferng, SH & Lin, CL 2014, 'Multidisciplinary care improves clinical outcome and reduces medical costs for pre-end-stage renal disease in Taiwan', Nephrology, vol. 19, no. 11, pp. 699-707. https://doi.org/10.1111/nep.12316
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. / Multidisciplinary care improves clinical outcome and reduces medical costs for pre-end-stage renal disease in Taiwan. In: Nephrology. 2014 ; Vol. 19, No. 11. pp. 699-707.
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abstract = "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 Taiwan. 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 Charlson Comorbidity Index 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.",
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AU - Lin, Ching Yuang

AU - Tsai, Wen Chen

AU - Chang, Jer Ming

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AB - 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 Taiwan. 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 Charlson Comorbidity Index 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.

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