Examination of resource use and clinical interventions associated with chronic kidney disease in a managed care population.
BACKGROUND
The management of chronic kidney disease (CKD) is multifaceted, including monitoring, early diagnosis, and treatment of comorbidities such as diabetes, hypoalbuminemia, and anemia, and initiating timely procedures in preparation for dialysis such as vascular access placement. Presumably, optimal care provided to patients during the predialysis phase will produce a significant impact on morbidity and mortality outcomes.


OBJECTIVE
A retrospective analysis was conducted to assess specific factors that may be associated with optimal quality of care for CKD patients during the predialysis phase.


METHODS
Health care resource utilization and the occurrence of interventions associated with optimal predialysis care were evaluated with claims data. Predialysis erythropoietin (EPO) therapy, nephrology referrals, and nutritional supplement administration were all examined during the 12 months prior to dialysis.


RESULTS
Medical and pharmacy claims from a managed care database were analyzed for 1,936 incident dialysis patients. Of these, 48.7% did not have any interventions associated with optimal care. Only a minority of patients received prescription iron preparations (6.8%), vitamin D (4.0%), and phosphate binders (7.7%). A total of 20.8% patients had a vascular access placement, and 29.8% were in the care of a nephrologist during this same time period. Only 10.5% received predialysis EPO, yet more than 40% were diagnosed with anemia. Of the EPO users, however, 72.4% were also receiving other interventions to appropriately manage CKD.


CONCLUSIONS
These claims-documented results suggest that the lack of EPO use in predialysis patients in a managed care plan may predict overall suboptimal treatment of these patients. There is an apparent need for the proactive management of CKD in a managed care plan to potentially redistribute or reduce health care resource utilization while improving patient outcomes.
London
Roger
R
Quality Management, Medical Affairs, Oxford Health Plans, White Plains, New York, USA. Rlondon@optonline.net
Solis
Amy
A
Goldberg
George A
GA
Wade
Sally
S
Chan
Wing W
WW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D005791:Patient Care / Q000191:economics; D004364:Pharmaceutical Preparations / Q000191:economics; D006435:Renal Dialysis / Q000191:economics; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D004364:Pharmaceutical Preparations