The integrated management for renal replacement therapy in Portugal

Abstract

Portugal was the first European country to introduce an integrated management of end-stage renal disease (IM ESRD). This new program integrates various dialysis services and products, which are reimbursed at a fixed rate/patient/week called "comprehensive price payment." This initiative restructured the delivery of dialysis services, the monitoring of outcomes, and the funding of renal replacement therapy. This article described the implementation of a new model of comprehensive provision of hemodialysis (HD) services and aimed to assess its impact on dialysis care. Quality assessments and reports of patient satisfaction, produced by the Ministry of Health since 2008, as well as national registries and reports, provided the data for this review. Indicators of HD services in all continental facilities show positive results that have successively improved along the period of 2009-2011, in spite of an average annual growth of 3% of the population under HD treatment. Mortality rates for HD patients were 12.7%, 12%, and 11%, respectively in 2009, 2010, and 2011; annual hospitalization rates were 4.9%, 3.8%, and 4.4% for the same years; key performance indicators showed averages above the reference values such as hemoglobin, serum phosphorus, eKt/V, water quality, number of days of hospitalization per patient per year, and number of weekly dialysis sessions. The financing analysis of IM ESRD demonstrates a sustained control of global costs, without compromising quality. The IM ERSD program is an innovative and quality-driven approach that benefits both dialysis patients and providers, contributing toward the rationalization of service provision and the efficient use of resources.

Survival and other clinical outcomes of maintenance hemodialysis patients in Taiwan: A 5‐year multicenter follow‐up study

“…In 2008, a quality‐driven integrated management program for ESRD patients has been introduced in Portugal. The concept of meticulous performance monitoring to facilitate a better dialysis outcome, similar to BSC concept, was proved to be effective in the 3‐year follow‐up period without increasing the medical expenditure . The balancing feature of BSC also prevents facilities running into operation problems due to wasting of the limited medical resources by monitoring all the aspects, in addition to medical therapy, such as the financial aspect.…”

“…The concept of meticulous performance monitoring to facilitate a better dialysis outcome, similar to BSC concept, was proved to be effective in the 3-year follow-up period without increasing the medical expenditure. 17 The balancing feature of BSC also prevents facilities running into operation problems due to wasting of the limited medical resources by monitoring all the aspects, in addition to medical therapy, such as the financial aspect. But because all the perspectives and targets in BSC are interconnected, a proper modification of action in one target will reflect a positive result in another target and vice versa.…”

Chronic Kidney Disease: Exploring Value-Based Healthcare as a Potential Viable Solution

“…From a cost perspective, the bundle showed a significant health system gain, and apart from a pre-arranged 14.3% reimbursement cut, a 10.5% total cost saving was observed mainly due to a reduction in unplanned hospitalization [64]. By shifting more care responsibility to the provider, a fair chance was given to find efficiencies along the treatment pathway without compromising patient outcome [65].…”

“…In 2014, a quality assessment following the introduction of the bundling scheme was conducted. Despite an increase of 3% of the haemodialysis population, a marked reduction in mortality and hospitalization rate was observed [65]. Moreover, patients felt more adequately informed about their treatment, which is positively related to a higher level of patient empowerment [65].…”

“…Despite an increase of 3% of the haemodialysis population, a marked reduction in mortality and hospitalization rate was observed [65]. Moreover, patients felt more adequately informed about their treatment, which is positively related to a higher level of patient empowerment [65]. From a cost perspective, the bundle showed a significant health system gain, and apart from a pre-arranged 14.3% reimbursement cut, a 10.5% total cost saving was observed mainly due to a reduction in unplanned hospitalization [64].…”