title: Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs.
abstract: OBJECTIVE
  Multidisciplinary care of patients with chronic kidney disease (CKD) provides better care outcomes. This study is to evaluate the effectiveness of a CKD care program on pre-end-stage renal disease (ESRD) care.
  
  
  METHODS
  One hundred and forty incident haemodialysis patients were classified into the CKD Care Group (n = 71) and the Nephrologist Care Group (n = 69) according to participation in the CKD care program before dialysis initiation. The 'total observation period' was divided into '6 months before dialysis' and 'at dialysis initiation'. Quality of pre-ESRD care, service utilization and medical costs were evaluated and compared between groups.
  
  
  RESULTS
  The mean estimated glomerular filtration rates at dialysis initiation were low in both groups; but the levels of haematocrit and serum albumin of the CKD Care Group were significantly higher. The percentages of patients initiating dialysis with created vascular access, without insertion of double-lumen catheter and without hospitalization were 57.7%, 50.7% and 40.8%, respectively, in the CKD Care Group, and 37.7%, 29.0% and 18.8% in the Nephrologist Care Group (P < 0.001). Participation in the CKD care program, though with higher costs during the 6 months before dialysis ($US1428 +/- 2049 vs US$675 +/- 962/patient, P < 0.001), was significantly associated with lower medical costs at dialysis initiation ($US942 +/- 1941 vs $US2410 +/- 2481/patient, P < 0.001) and for the total period of observation ($US2674 +/- 2780 vs $US3872 +/- 3270/patient, P = 0.009). The cost-saving effect came through the early preparation of vascular access and the lack of hospitalization at dialysis initiation.
  
  
  CONCLUSIONS
  CKD care programs significantly improve quality of pre-ESRD care, decrease service utilization and save medical costs.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan.
authors.forename: Shu-Yi
authors.initials: SY
authors.lastname: Wei
authors.forename: Yong-Yuan
authors.initials: YY
authors.lastname: Chang
authors.forename: Lih-Wen
authors.initials: LW
authors.lastname: Mau
authors.forename: Ming-Yen
authors.initials: MY
authors.lastname: Lin
authors.forename: Herng-Chia
authors.initials: HC
authors.lastname: Chiu
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Huang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
mesh_terms: D002908:Chronic Disease; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000191:economics* / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011787:Quality of Health Care; D012189:Retrospective Studies