National Kidney Foundation, 30 E 33rd St, New York, NY 10016. Email:
Am J Manag Care. 2019 Nov 1;25(11):e326-e333.
To execute a chronic kidney disease (CKD) intervention to assess feasibility and preliminary outcomes for a health plan.
This CKD quality improvement study was incorporated into an existing CareFirst primary care patient-centered medical home cohort with a pre- and postintervention assessment from July 1, 2015, to June 30, 2017.
The study targeted the population at risk for CKD with diabetes and/or hypertension by implementing a care plan according to the stratification by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) or CKD heat map class.
The population included 7420 individuals (51.8% female) with a mean age of 55.9 years; 19.1% had diabetes only, 42.2% had hypertension only, and 38.2% had both conditions. Overall, there was no change in eGFR testing among risk groups (84.8%), but a small significant increase in uACR testing occurred (from 31.3% to 33.0%; P = .0020). Reductions in admissions per 1000 patients were from 362.5 to 249.0 for class 3, 311.7 to 219.2 for class 4, and 590.9 to 323.5 for class 5. Lastly, there were reductions in 30-day readmissions per 1000 patients, from 51.9 to 13.7 for class 4 and 45.5 to 0 for class 5. Although there were increases in many of the per-member per-month costs assessed pre- versus post intervention, net savings in medical costs were $276.80 and $480.79 for CKD classes 3 and 5, respectively.
This scalable CKD intervention demonstrated feasibility. For advanced CKD, decreased hospitalization and a reduction in several important costs were observed. These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans.
执行一项慢性肾脏病 (CKD) 干预措施，评估该计划对健康保险的可行性和初步效果。
这项 CKD 质量改进研究纳入了现有的 CareFirst 初级保健以患者为中心的医疗之家队列，从 2015 年 7 月 1 日至 2017 年 6 月 30 日进行了干预前后评估。
该研究通过根据估算肾小球滤过率 (eGFR) 和尿白蛋白/肌酐比 (uACR) 或 CKD 热图分类对有风险的 CKD 人群实施护理计划，以实现对糖尿病和/或高血压患者的目标管理。
该人群包括 7420 名个体（51.8%为女性），平均年龄为 55.9 岁；19.1%仅有糖尿病，42.2%仅有高血压，38.2%两者兼有。总体而言，风险人群的 eGFR 检测没有变化（84.8%），但 uACR 检测略有显著增加（从 31.3%增至 33.0%；P=.0020）。每 1000 名患者的入院人数减少，3 类从 362.5 人降至 249.0 人，4 类从 311.7 人降至 219.2 人，5 类从 590.9 人降至 323.5 人。最后，每 1000 名患者的 30 天再入院人数减少，4 类从 51.9 人降至 13.7 人，5 类从 45.5 人降至 0 人。虽然干预前后每会员每月评估的许多费用都有所增加，但 CKD 3 类和 5 类的医疗费用分别节省了 276.80 美元和 480.79 美元。
这项可扩展的 CKD 干预措施具有可行性。对于晚期 CKD，观察到住院人数减少和多个重要成本降低。这些初步结果支持对商业健康计划的 CKD 人群健康创新进行实验室数据分层。
