title: Multidisciplinary care improves clinical outcome and reduces medical costs for pre-end-stage renal disease in Taiwan.
abstract: OBJECTIVE
  Multidisciplinary care (MDC) for patients with chronic kidney disease (CKD) may help to optimize disease care and improve clinical outcomes. Our study aimed to evaluate the effectiveness of pre-end-stage renal disease (ESRD) patients under MDC and usual care in Taiwan.
  
  
  METHODS
  In this 3-year retrospective observational study, we recruited 822 ESRD subjects, aged 18 years and older, initiating maintenance dialysis more than 3 months from five cooperating hospitals. The MDC (n = 391) group was cared for by a nephrologists-based team and the usual care group (n = 431) was cared for by sub-specialists or nephrologists alone more than 90 days before dialysis initiation. Patient characteristics, dialysis modality, hospital utilization, hospitalization at dialysis initiation, mortality and medical cost were evaluated. Medical costs were further divided into in-hospital, emergency services and outpatient visits.
  
  
  RESULTS
  The MDC group had a better prevalence in peritoneal dialysis (PD) selection, less temporary catheter use, a lower hospitalization rate at dialysis initiation and 15% reduction in the risk of hospitalization (P < 0.05). After adjusting for gender, age and Charlson Comorbidity Index score, there were lower in-hospital and higher outpatient costs in the MDC group during 3 months before dialysis initiation (P < 0.05). In contrast, medical costs (NT$ 146,038 vs 79,022) and hospitalization days (22.4 vs 15.5 days) at dialysis initiation were higher in the usual care group. Estimated medical costs during 3 months before dialysis till dialysis initiation, the MDC group yielded a reduction of NT$ 59,251 for each patient (P < 0.001). Patient mortality was not significantly different.
  
  
  CONCLUSIONS
  Multidisciplinary care intervention for pre-ESRD patients could not only significantly improve the quality of disease care and clinical outcome, but also reduce medical costs.
authors: Division of Nephrology, Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan.
authors: Yue-Ren
authors: YR
authors: Chen
authors: Yu
authors: Y
authors: Yang
authors: Shu-Chuan
authors: SC
authors: Wang
authors: Wen-Yu
authors: WY
authors: Chou
authors: Ping-Fang
authors: PF
authors: Chiu
authors: Ching-Yuang
authors: CY
authors: Lin
authors: Wen-Chen
authors: WC
authors: Tsai
authors: Jer-Ming
authors: JM
authors: Chang
authors: Tzen-Wen
authors: TW
authors: Chen
authors: Shyang-Hwa
authors: SH
authors: Ferng
authors: Chun-Liang
authors: CL
authors: Lin
mesh_terms: D017046:Cost Savings; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome
keywords: chronic kidney disease; hospitalization; medical costs; mortality; multidisciplinary care