Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study
Objectives To control and prevent the burdens associated with chronic kidney disease (CKD), Taiwan’s National Health Insurance Administration (NHIA) launched the ‘early-CKD programme’ in 2011 to extend care and education to patients with CKD. This study aims to evaluate the effectiveness of the earl...
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doaj-83679f2c323d4a8da5489b7b978b997c2021-09-16T01:00:05ZengBMJ Publishing GroupBMJ Open2044-60552020-12-01101210.1136/bmjopen-2020-041149Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal studyYin-Cheng Chen0Shuen-Fu Weng1Yu-Juei Hsu2Chung-Jen Wei3Chiung-hsuan Chiu4Division of Nephrology, Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, TaiwanDivision of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Public Health, Fu Jen Catholic University, New Taipei City, TaiwanSchool of Health Care Administration, Taipei Medical University, Taipei, TaiwanObjectives To control and prevent the burdens associated with chronic kidney disease (CKD), Taiwan’s National Health Insurance Administration (NHIA) launched the ‘early-CKD programme’ in 2011 to extend care and education to patients with CKD. This study aims to evaluate the effectiveness of the early-CKD programme in terms of continuity of care (COC).Design and participants This study used secondary data from 2010 to 2014 provided by the NHIA to identify 86 581 participants each for the intervention and control groups. Patients with CKD who participated in the early-CKD programme between 2011 and 2013 were defined as the intervention group. For the control group, propensity score matching was used to select patients with CKD who did not participate in the programme, but were seen by the same group of physicians.Intervention A multidisciplinary care model for patients with early CKD launched in 2011.Primary outcome measures Outcome variables included the continuity of care index (COCI), which measures a physician’s COC; number of essential examinations; and resource utilisation. To better identify the difference between groups, we separated COCI into two groups based on mean: high (above mean) and low (below mean). A generalised estimating equation model was used to examine the effects of the early-CKD programme.Results The programme significantly increased the number of essential examinations/tests administered to patients (β=0.61, p<0.001) and improved COCI between physicians and patients (OR=4.18, p<0.001). Medical expenses (β=1.03, p<0.001) and medication expenses (β=0.23, p<0.001) significantly increased after the programme was implemented, but patients’ kidney-related hospitalisations and emergency department visits decreased (β=−0.13, p<0.001).Conclusion From the COC viewpoint, the programme in Taiwan showed a positive effect on COCI, number of essential examinations and resource utilisation.https://bmjopen.bmj.com/content/10/12/e041149.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yin-Cheng Chen Shuen-Fu Weng Yu-Juei Hsu Chung-Jen Wei Chiung-hsuan Chiu |
spellingShingle |
Yin-Cheng Chen Shuen-Fu Weng Yu-Juei Hsu Chung-Jen Wei Chiung-hsuan Chiu Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study BMJ Open |
author_facet |
Yin-Cheng Chen Shuen-Fu Weng Yu-Juei Hsu Chung-Jen Wei Chiung-hsuan Chiu |
author_sort |
Yin-Cheng Chen |
title |
Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study |
title_short |
Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study |
title_full |
Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study |
title_fullStr |
Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study |
title_full_unstemmed |
Continuity of care: evaluating a multidisciplinary care model for people with early CKD via a nationwide population-based longitudinal study |
title_sort |
continuity of care: evaluating a multidisciplinary care model for people with early ckd via a nationwide population-based longitudinal study |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2020-12-01 |
description |
Objectives To control and prevent the burdens associated with chronic kidney disease (CKD), Taiwan’s National Health Insurance Administration (NHIA) launched the ‘early-CKD programme’ in 2011 to extend care and education to patients with CKD. This study aims to evaluate the effectiveness of the early-CKD programme in terms of continuity of care (COC).Design and participants This study used secondary data from 2010 to 2014 provided by the NHIA to identify 86 581 participants each for the intervention and control groups. Patients with CKD who participated in the early-CKD programme between 2011 and 2013 were defined as the intervention group. For the control group, propensity score matching was used to select patients with CKD who did not participate in the programme, but were seen by the same group of physicians.Intervention A multidisciplinary care model for patients with early CKD launched in 2011.Primary outcome measures Outcome variables included the continuity of care index (COCI), which measures a physician’s COC; number of essential examinations; and resource utilisation. To better identify the difference between groups, we separated COCI into two groups based on mean: high (above mean) and low (below mean). A generalised estimating equation model was used to examine the effects of the early-CKD programme.Results The programme significantly increased the number of essential examinations/tests administered to patients (β=0.61, p<0.001) and improved COCI between physicians and patients (OR=4.18, p<0.001). Medical expenses (β=1.03, p<0.001) and medication expenses (β=0.23, p<0.001) significantly increased after the programme was implemented, but patients’ kidney-related hospitalisations and emergency department visits decreased (β=−0.13, p<0.001).Conclusion From the COC viewpoint, the programme in Taiwan showed a positive effect on COCI, number of essential examinations and resource utilisation. |
url |
https://bmjopen.bmj.com/content/10/12/e041149.full |
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