Clinical outcomes, quality of life, and costs evaluation of peritoneal dialysis management models in Shanghai Songjiang District: a multi-center and prospective cohort study

Abstract

Background:The new Family-Community-Hospital (FCH) three-level comprehensive management aimed to improve the efficiency and scale of peritoneal dialysis (PD) to meet the increased population of end-stage renal disease (ESRD). Our study focused on the clinical outcomes, quality of life, and costs evaluation of this model in a multi-center and prospective cohort study. Methods: A total of 190 ESRD patients who commenced PD at Shanghai Songjiang District were enrolled. According to different PD management models, patients were divided into the Family-Community-Hospital three-level management model (n ¼ 90) and the conventional all-course central hospital management model (n ¼ 100). The primary outcome was clinical outcomes of PD. The secondary outcomes were health-related quality of life (HRQOL) and medical costs evaluation. Results: Compared to conventional management, community-based FCH management achieved a similar dialysis therapeutic effect, including dropout rate (p ¼ 0.366), peritonitis rate (p ¼ 0.965), patient survival (p ¼ 0.441), and technique survival (p ¼ 0.589). Follow-up data showed that similar levels of the renal and peritoneal functions, serum albumin, cholesterol and triglyceride, PTH, serum calcium, and phosphorus between the two groups (all p > 0.05). HRQOL survey showed that the FCH management model helped to improve the psychological status of PD patients, including social functioning (p ¼ 0.006), role-emotional (p ¼ 0.032), and mental health (p ¼ 0.036). FCH management also reduced the hospitalization (p ¼ 0.009) and outpatient visits (p ¼ 0.001) and saved annual hospitalization costs (p ¼ 0.005), outpatient costs (p ¼ 0.026), and transport costs (p ¼ 0.006). Conclusions: Compared with conventional management, community-based FCH management achieved similar outcomes, improved psychological health, reduced medical budgets, and thus had a good social prospect.

Characterizing Interventions Used to Promote Life Participation in Adults on Peritoneal Dialysis Therapy: A Scoping Review

“…We screened 13 874 studies, of which 17 met eligibility criteria and were found to be eligible for this review ( Figure 1 ). The majority of studies (n = 8) were conducted between 2017 and 2022, 27 - 34 with 3 studies conducted between 2012 and 2016 35 - 37 and 6 studies conducted prior to 2011. 38 - 43 The most common study location was China 29 , 32 , 33 , 35 , 38 , 40 , 42 , 43 ; other locations included Canada, 31 , 41 Italy, 28 , 34 England, 36 Japan, 27 Sweden, 37 Thailand, 30 and the United States.…”

“…The majority of studies (n = 8) were conducted between 2017 and 2022, 27 - 34 with 3 studies conducted between 2012 and 2016 35 - 37 and 6 studies conducted prior to 2011. 38 - 43 The most common study location was China 29 , 32 , 33 , 35 , 38 , 40 , 42 , 43 ; other locations included Canada, 31 , 41 Italy, 28 , 34 England, 36 Japan, 27 Sweden, 37 Thailand, 30 and the United States. 39 The median study sample size was 36, and 9 studies (53%) were randomized controlled trials.…”

“… 39 The median study sample size was 36, and 9 studies (53%) were randomized controlled trials. 27 - 29 , 32 , 34 - 36 , 39 , 42 Thirteen studies were published in medical journals, 27 , 28 , 31 - 36 , 38 , 39 , 41 , 43 with the remainder of studies appearing in nursing journals 30 , 37 , 40 , 42 or a nutrition journal. 29 Study characteristics are outlined in Table 2 .…”

“…32 One study targeted an institutional-environmental barrier to life participation, using a broadened 3-level family, community and hospital-based care model to better support PD patients with their disease management. 33 No interventions exclusively targeted cognitive or affective barriers to life participation, nor did any studies exclusively address physical, social or cultural environmental barriers. Interventions are further described in Table 2 .…”

“…Life participation was almost exclusively investigated as a secondary outcome in the identified studies, 27 - 30 , 32 - 42 with only 2 studies focusing on it as a primary outcome. 31 , 43 It was most frequently captured within broader quality of life assessments, with 11 studies (65%) exclusively relying on the role-physical, role-emotional, social functioning, and/or quality of social interaction subscales from the 36-Item Short-Form Health Survey SF-36 or the Kidney Disease Quality of Life (KDQOL)-36 assessments 27 - 29 , 33 , 34 , 36 - 39 , 41 , 42 to assess life participation.…”