title: Multidisciplinary team care may slow the rate of decline in renal function.
abstract: OBJECTIVE
  A multidisciplinary team (MDT) approach to chronic kidney disease (CKD) may help optimize care of CKD and comorbidities. We implemented an MDT quality improvement project for persons with stage 3 CKD and comorbid diabetes and/or hypertension. Our objective was to decrease the rate of decline of GFR.
  
  
  METHODS
  We used a 4-year historical cohort to compare 1769 persons referred for usual nephrology care versus 233 referred for MDT care within an integrated, not-for-profit Health Maintenance Organization (HMO). Usual care consisted of referral to an outside nephrologist. The MDT consisted of an HMO-based nephrologist, pharmacy specialist, diabetes educator, dietitian, social worker, and nephrology nurse. Both groups received usual primary care. The primary outcome was rate of decline of GFR. Secondary outcomes were LDL, hemoglobin A1c, and BP.
  
  
  RESULTS
  In multivariate repeated-measures analyses, MDT care was associated with a mean annual decline in GFR of 1.2 versus 2.5 ml/min per 1.73 m(2) for usual care. In stratified analyses, the significant difference in GFR decline persisted only in those who completed their referrals. There were no differences in the secondary outcomes between groups.
  
  
  CONCLUSIONS
  In this integrated care setting, MDT care resulted in a slower decline in GFR than usual care. This occurred despite a lack of significant differences for secondary disease-specific measures, suggesting that other differences in the MDT population or care process accounted for the slower decline in GFR in the MDT group.
authors.affiliation: Kaiser Permanente, Institute for Health Research, 10065 E. Harvard Avenue, Suite 300, Denver, CO 80231, USA. Elizabeth.Bayliss@KP.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
authors.forename: Bharati
authors.initials: B
authors.lastname: Bhardwaja
authors.forename: Colleen
authors.initials: C
authors.lastname: Ross
authors.forename: Arne
authors.initials: A
authors.lastname: Beck
authors.forename: Diane M
authors.initials: DM
authors.lastname: Lanese
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010348:Patient Care Team