title: Telemedically Supported Case Management of Living-Donor Renal Transplant Recipients to Optimize Routine Evidence-Based Aftercare: A Single-Center Randomized Controlled Trial.
abstract: Improving mid-term and long-term outcomes after solid organ transplantation is imperative, and requires both state-of-the-art transplant surgery and optimization of routine, evidence-based aftercare. This randomized, controlled trial assessed the effectiveness of standard aftercare versus telemedically supported case management, an innovative aftercare model, in 46 living-donor renal transplant recipients during the first posttransplant year. The model includes three components: (i) chronic care case management initiated after discharge, (ii) case management initiated in emerging acute care situations, and (iii) a telemedically equipped team comprising a transplant nurse case manager and two senior transplant physicians (nephrologist, surgeon). Analyses revealed a reduction of unplanned inpatient acute care, with considerable cost reductions, in the intervention group. The prevalence of nonadherence over the 1-year study period was 17.4% in the intervention group versus 56.5% in the standard aftercare group (p = 0.013). Only the intervention group achieved their pre-agreed levels of adherence, disease-specific quality of life, and return to employment. This comparative effectiveness study provides the basis for multicenter study testing of telemedically supported case management with the aim of optimizing posttransplant aftercare. The trial was registered with the German Clinical Trials Register (www.DRKS.de), DKRS00007634.
authors.affiliation: Department of General and Visceral Surgery, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schmid
authors.affiliation: Department of General and Visceral Surgery, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hils
authors.affiliation: Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kramer-Zucker
authors.affiliation: Center for Medical Biometry and Medical Informatics, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Bogatyreva
authors.affiliation: Center for Medical Biometry and Medical Informatics, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Hauschke
authors.affiliation: Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland.|Academic Center of Nursing and Midwifery, Department Public Health and Primary Care, KU-Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: De Geest
authors.affiliation: Department of General and Visceral Surgery, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Pisarski
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000368:Aged; D019090:Case Management; D055317:Evidence-Based Practice; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D017216:Telemedicine / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: compliance/adherence; health services and outcomes research; hospital readmission; kidney transplantation/nephrology; kidney transplantation: living donor; quality of care/care delivery; quality of life (QOL)