Effect of national pre-ESRD care program on expenditures and mortality in incident dialysis patients: A population-based study

Lin, Ming-Yen; Cheng, Lie; Chiu, Yi‐Wen; Hsieh, Hui‐Min; Wu, Ping-Hsun; Lin, Yi-Ting; Wang, Shuli; Jian, Feng-Xuan; Hsu, Chih Cheng; Yang, Shi‐Ming; Lee, Huei-Lan; Hwang, Shang‐Jyh

doi:10.1371/journal.pone.0198387

Cited by 35 publications

(47 citation statements)

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“…25 In addition, the Korean national P4P (pre-dialysis program), implemented with a multidisciplinary team care model, significantly improved the quality of CKD management, and reduced the risk of early mortality and health care expenses. 26 Finally, Strand et al 27 , in their systematic review in 2012, established that multidisciplinary care is effective in delaying the progression of CKD in adults, especially in the advanced stages. Education becomes an important component of care by increasing knowledge and understanding of the causes of CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Así mismo, el programa P4P (programa de pre diálisis) nacional coreano, implementado con un modelo de atención en equipo multidisciplinario, mejoró significativamente la calidad del manejo de ERC, y redujo el riesgo de mortalidad temprana y los gastos de atención de la salud. 26 Finalmente, Strand et al 27 , en su revisión sistemática en el 2012, establecieron que la atención multidisciplinaria es eficaz para retrasar la progresión de la ERC en adultos, especialmente en los estadios avanzados. La educación se convierte en un componente importante de la atención logrando aumentar el conocimiento y la comprensión de las causas de la ERC.…”

Section: Discussionunclassified

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Effectiveness of adherence to a renal health program in a health network in Peru

et al. 2020

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OBJECTIVE: To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS: We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS: A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41–0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57–0.83). CONCLUSIONS: The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

Effectiveness of adherence to a renal health program in a health network in Peru

et al. 2020

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“…In addition, even when kidney function deteriorated and the patient required long-term dialysis, the 4-year total healthcare expenditures of patients enrolled in the P4P programme continued to show a 68% reduction compared with those without healthcare from the P4P programme. The mortality within 3 years of dialysis of the patients with P4P programme care was also significantly lower than those without P4P programme care 10…”

Section: Introductionmentioning

confidence: 85%

Patient and provider factors associated with enrolment in the pre-end-stage renal disease pay-for-performance programme in Taiwan: a cross-sectional study

Hu¹,

Jian

Lai

et al. 2019

BMJ Open

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ObjectiveThe incidence and prevalence of end-stage renal disease (ESRD) in Taiwan have been ranked the highest worldwide. Therefore, the National Health Insurance Administration has implemented the pre-ESRD pay-for-performance (P4P) programme since November 2006, which had significantly reduced the incidence of dialysis and all-cause mortality. This study aimed to identify the factors associated with the enrolment in the pre-ESRD P4P programme.DesignCross-sectional study.SettingThe National Health Insurance research database 2007–2012 in Taiwan.ParticipantsPatients with prevalent pre-ESRD aged more than 18 years between January 2007 and December 2012 were enrolled. Patient demographics and hospital characteristics between P4P and non-P4P groups were compared. A logistic regression model was used to analyse the factors associated with P4P enrolment, and a generalised estimating equation was used to verify the results.Primary outcome measureEnrolment in the pre-ESRD P4P programme.ResultsIn total, 82 991 patients were enrolled in the programme, with a 45.6% participation rate. Patients who were males (adjusted OR (AOR)=0.89, 95% CI=0.86 to 0.91) and employed (AOR=0.95, 95% CI=0.92 to 0.97) had a significantly lower probability to be enrolled in the programme. Older patients (66–75 years old, AOR=1.23, 95% CI=1.14 to 1.33) and those with higher Charlson Comorbidities Index (CCI 5+, AOR=4.01, 95% CI=3.55 to 4.53) tended to be enrolled in the programme, while those in the 76+ years age group were not (AOR=1.03, 95% CI=0.95 to 1.13). Hospitals located in the central (AOR=1.48, 95% CI=1.05 to 2.08) and Kao-Ping regions (AOR=1.62, 95% CI=1.18 to 2.22) also tended to enrol patients in the pre-ESRD P4P programme. Enrolment rates increased over time.ConclusionPre-ESRD patients of the female gender, greater age and more comorbidities were more likely to be enrolled in the pre-ESRD P4P programme. Healthcare providers and health authorities should focus attention on patients who are male, younger and with less comorbidities to improve the healthcare quality and equality for all pre-ESRD patients.

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“…Cardiovascular (CV) disease is one of the leading causes of mortality in this population. Therefore, there are many programs of quality care and medical therapies developed to control the growing incidence, prevalence, and mortality for the patients with CKD 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Using CHADS2 and CHA2DS2-VASc scores for mortality prediction in patients with chronic kidney disease

Hsu

Lee

Chen

et al. 2020

Sci Rep

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Chronic kidney disease (CKD) is a public health issue and is associated with high morbidity and mortality. How to identify the high-risk CKD patients is very important to improve the long-term outcome. CHADS2 and CHA2DS2-VASc scores are clinically useful scores to evaluate the risk of stroke in patients with atrial fibrillation. However, there was no literature discussing about the usefulness of CHADS2 and CHA2DS2-VASc scores for cardiovascular (CV) and all-cause mortality prediction in CKD patients. This longitudinal study enrolled 437 patients with CKD. CHADS2 and CHA2DS2-VASc scores were calculated for each patient. CV and all-cause mortality data were collected for long-term outcome prediction. The median follow-up to mortality was 91 (25th–75th percentile: 59–101) months. There were 66 CV mortality and 165 all-cause mortality. In addition to age and heart rate, CHADS2 and CHA2DS2-VASc scores (both P value < 0.001) were significant predictors of CV and all-cause mortality in the multivariate analysis. Besides, in direct comparison of multivariate model, basic model + CHA2DS2-VASc score had a better additive predictive value for all-cause mortality than basic model + CHADS2 score (P = 0.031). In conclusion, our study showed both of CHADS2 and CHA2DS2-VASc scores were significant predictors for long-term CV and all-cause mortality in CKD patients and CHA2DS2-VASc score had a better predictive value than CHADS2 score for all-cause mortality in direct comparison of multivariate model. Therefore, using CHADS2 and CHA2DS2-VASc scores to screen CKD patients may be helpful in identifying the high-risk group with increased mortality.

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Effect of national pre-ESRD care program on expenditures and mortality in incident dialysis patients: A population-based study

Cited by 35 publications

References 28 publications

Effectiveness of adherence to a renal health program in a health network in Peru

Effectiveness of adherence to a renal health program in a health network in Peru

Patient and provider factors associated with enrolment in the pre-end-stage renal disease pay-for-performance programme in Taiwan: a cross-sectional study

Using CHADS2 and CHA2DS2-VASc scores for mortality prediction in patients with chronic kidney disease

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