NHMRC Chronic Kidney Disease Centre of Research Excellence, The University of Queensland, Herston, Queensland, Australia.
Centre for the Business and Economics of Health, The University of Queensland, Woolloongabba, Queensland, Australia.
J Palliat Care. 2020 Jul;35(3):176-184. doi: 10.1177/0825859719868174. Epub 2019 Aug 28.
Kidney supportive care (KSC) is a patient-centered model of multidisciplinary care designed for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Our goal was to characterize the types, frequencies, and costs of services accessed by patients enrolled in a KSC program. We analyzed health care utilization data prospectively collected from 102 patients who enrolled in the KSC program during the first 52 weeks of its existence. The data comprised program appointments, emergency department presentations, ambulance service use, outpatient visits, inpatient episodes, and dialysis treatments made within the Brisbane area of Metro North. Costs of resource use were estimated using Queensland Health funding principles and guidelines. Analyses included descriptive statistics, correlations, and multivariate regressions. During the median program participation of 22 weeks, patients had 3975 contacts with health care, with the total value of services amounting to nearly A$3 million. Dialysis treatments accounted for 70% of visits and 49% of costs. Patients receiving dialysis had higher utilization of outpatient services and associated cost, compared to patients who were not dialyzed. The presence of diabetes and the choice of conservative pathway were both predictors of higher frequency and cost of services. Longer program participation was associated with lower weekly utilization and cost. The program attracted patients representing various characteristics, pathways, needs, and outcomes. Exploring these patterns will enable better understanding of the patient population and improved service planning, in KSC and similar programs that aim to comprehensively address the needs of patients with advanced CKD and ESKD.
肾脏支持治疗 (KSC) 是以患者为中心的多学科护理模式，专为晚期慢性肾脏病 (CKD) 和终末期肾病 (ESKD) 患者设计。我们的目标是描述参与 KSC 计划的患者所获得的服务类型、频率和成本。我们分析了前瞻性收集的 102 名患者的医疗保健利用数据，这些患者在 KSC 计划存在的前 52 周内参与了该计划。数据包括计划预约、急诊科就诊、救护车服务使用、门诊就诊、住院病例和布里斯班地区 Metro North 内的透析治疗。使用昆士兰州卫生厅的资助原则和指南估算资源使用成本。分析包括描述性统计、相关性和多元回归。在中位数为 22 周的计划参与期间，患者与医疗保健机构进行了 3975 次接触，服务总价值近 300 万澳元。透析治疗占就诊次数的 70%，占费用的 49%。与未透析的患者相比，接受透析的患者门诊服务和相关费用的利用率更高。存在糖尿病和保守治疗途径的选择是服务频率和成本更高的预测因素。参与计划的时间越长，每周的利用率和成本越低。该计划吸引了具有各种特征、途径、需求和结果的患者。探索这些模式将有助于更好地了解患者群体，并改进 KSC 和类似计划的服务规划，这些计划旨在全面满足晚期 CKD 和 ESKD 患者的需求。
