Ordaz Jurado Domingo de Guzmán, Budía Alba Alberto, López-Acón Daniel, Gadea Company Patricia, Boronat Tormo Francisco
Unidad de Litotricia y Endourología. Hospital Universitari i Politècnic La Fe de Valencia. España.
Arch Esp Urol. 2021 Jan;74(1):129-134.
Stone disease is a chronic condition in a high percentage of patients. Duento the high healthcare costs associated with the treatment of this pathology, chronicity approaches and strategies should be adapted and used in a similar way to other chronic diseases. One of the models applied for the management of these diseases with a significant impact on the consumption of health resources is the Kaiser Permanente model.
A chronic stone disease management project was developed and carried out in three different phases: Phase 1: identification of the target population of the program and design of the risk allocation model. The risk factors considered were CRG model (classification of risk groups or burden of morbidity) as a predictor of greater consumption of resources, anatomical risk factors, lithogenic risk factors, and hereditary factors associated with lithiasis. Phase 2: classification of patients according to risk and application of specific measures. The intervention measures will depend on the level of risk assigned: low, intermediate or high risk. Phase 3: analysis of indicators and results.
An algorithm of risk allocation was designed, and a Kaiser pyramid drawn. A total of 59% of the patients were assigned to the low-risk group and 41% corresponded to high-risk (36.5%) or very high-risk patients (4.5%). Preliminary results obtained at two years of follow-up show a reduction in global stone recurrence by 42.2% when compared with a control group (classic follow-up). The overall adherence of the intervention group was 96.4% and the satisfaction of the patients included in the program was 9.93/10.
A management model for chronic stone disease based on the Kaiser Permanente pyramidis feasible. The implantation of this model has preliminarily demonstrated its efficiency in chronic patients.
结石病在很大比例的患者中属于慢性疾病。鉴于与该疾病治疗相关的高昂医疗成本，应采用与其他慢性病类似的慢性管理方法和策略。对卫生资源消耗有重大影响的用于管理这些疾病的模式之一是凯撒医疗模式。
开展了一个慢性结石病管理项目，分三个不同阶段进行：第一阶段：确定项目的目标人群并设计风险分配模型。所考虑的风险因素包括作为资源消耗增加预测指标的CRG模型（风险组分类或发病负担）、解剖学风险因素、结石形成风险因素以及与结石症相关的遗传因素。第二阶段：根据风险对患者进行分类并应用具体措施。干预措施将取决于所分配的风险水平：低、中或高风险。第三阶段：分析指标和结果。
设计了一个风险分配算法，并绘制了一个凯撒金字塔图。共有59%的患者被分配到低风险组，41%对应高风险（36.5%）或极高风险患者（4.5%）。两年随访获得的初步结果显示，与对照组（传统随访）相比，结石总体复发率降低了42.2%。干预组的总体依从率为96.4%，纳入该项目的患者满意度为9.93/10。
基于凯撒医疗金字塔的慢性结石病管理模式是可行的。该模式的实施已初步证明其对慢性病患者的有效性。
