Clinical outcomes of hemodialysis patients in a public-private partnership care framework in Italy: a retrospective cohort study

Abstract

BackgroundInnovative care models such as public-private partnerships (PPPs) may help meet the challenge of providing cost-effective high-quality care for the steadily growing and complex chronic kidney disease population since they combine the expertise and efficiency of a specialized dialysis provider with the population care approach of a public entity. We report the five-years main clinical outcomes of a population of patients treated on hemodialysis within a PPP-care model in Italy.MethodsThis descriptive retrospective cohort study consisted of all consecutive hemodialysis patients treated in the NephroCare-operated Nephrology and Dialysis unit of the Seriate Hospital in 2012–2016, which exercises a PPP-care model. Clinical and treatment information was obtained from the European Clinical Database. Hospitalization outcomes and cumulative all-cause mortality incidences that accounted for competing risks were calculated.ResultsWe included 401 hemodialysis patients (197 prevalent and 204 incident patients) in our study. The mean cohort age and age-adjusted Charlson Comorbidity Index were 67.0 years and 6.7, respectively. Patients were treated with online high-volume hemodiafiltration or high-flux hemodialysis. Parameters of treatment efficiency were above the recommended targets throughout the study period. Patients in the PPP experienced benefits in terms of hospitalization (average number of hospital admissions/patient-year: 0.79 and 1.13 for prevalent and incident patients, respectively; average length of hospitalization: 8.9 days for both groups) and had low cumulative all-cause mortality rates (12 months: 10.6 and 7.8%, 5 years: 42.0 and 35.9%, for prevalent and incident patients, respectively).ConclusionsResults of our descriptive study suggest that hemodialysis patients treated within a PPP-care model framework received care complying with recommended treatment targets and may benefit in terms of hospitalization and mortality outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12882-019-1224-2) contains supplementary material, which is available to authorized users.

Hospital services under public-private partnerships, outcomes and, challenges: A literature review

“…In addition to showing good performance in establishing diagnosis and therapy, hospitals with PPP have also been shown to be successful in reducing the length of stay both in general 3 and in specialist treatments such as endovascular surgery 46 and hemodialysis. 33 , 48 In hemodialysis services, PPP was known to successfully reduce the length of stay and the prevalence and incidence of hospitalization. 33 Reinforcing the study of Pedrini et al, 33 PPP was better in terms of service, duration and sessions of hemodialysis.…”

“… 33 , 48 In hemodialysis services, PPP was known to successfully reduce the length of stay and the prevalence and incidence of hospitalization. 33 Reinforcing the study of Pedrini et al, 33 PPP was better in terms of service, duration and sessions of hemodialysis. 48 Several studies described the success of PPP in reducing mortality.…”

“… 33 Hemodialysis patients who received treatment at a health facility with PPP received treatment according to the recommended treatment targets, reducing the length of stay and mortality. 33 …”

Clinical and ultrasonographic screening for carpal tunnel syndrome in hemodialysis patients

“…Maintenance hemodialysis (HD) therapy is the most common mode of renal replacement therapy [2]. HD patients are susceptible to many comorbid conditions, such as cardiovascular disease, anemia, and peripheral neuropathy [3].Peripheral neuropathy is a common complication that affects 60% to 100% of chronic kidney disease (CKD) patients [4]. Despite the adequacy of dialysis, peripheral neuropathy remains a major disabling problem that has a negative impact on the health-related quality of life of such patients [4].…”

“…Maintenance hemodialysis (HD) therapy is the most common mode of renal replacement therapy [2]. HD patients are susceptible to many comorbid conditions, such as cardiovascular disease, anemia, and peripheral neuropathy [3].…”