BACKGROUND: Optimal utilization of health care resources for patients with chronic conditions is an increasing focus of health care policy researchers and clinicians. Kidney disease, diabetes (DM) and cardiovascular disease (CVD) often coexist within one individual, but current systems are designed to manage individual conditions. We sought to examine if streamlining medical care of complex patients (two or more conditions) is associated with similar, worse or improved outcomes using a randomized controlled study design. METHODS:Patients attending a kidney care clinic (KCC) and at least one other specialty clinic of interest (DM, CVD) were randomly assigned to either the 'combined clinic (CC)' arm, where resources from all three were integrated into one clinic, or to the 'standard care' arm with continued attendance at multiple specialty clinics (MC), including the KCC. The primary outcome was hospitalization rate and sample size was calculated based on non-inferiority. RESULTS: Of 150 subjects enrolled, 11 subjects exited before study commencement: 139 remained for final analysis. Other than older age in the MC group (P = 0.009), the demographics were comparable. Hospitalization rates were not different (95% CI for the difference: 0.013-0.207; P = 0.03). Similar proportions in each group achieved clinical and laboratory targets. Mortality (13%) and dialysis (32%) rates were the same between groups. Differences in the cost of clinic visits alone were $86,400 per year in favor of the CC. CONCLUSIONS: Medical care of complex patients may be delivered in a single combined specialty clinic as compared to multiple disease specific clinics without compromising patient care or important health outcomes, with demonstrable outpatient costs savings.
RCT Entities:
BACKGROUND: Optimal utilization of health care resources for patients with chronic conditions is an increasing focus of health care policy researchers and clinicians. Kidney disease, diabetes (DM) and cardiovascular disease (CVD) often coexist within one individual, but current systems are designed to manage individual conditions. We sought to examine if streamlining medical care of complex patients (two or more conditions) is associated with similar, worse or improved outcomes using a randomized controlled study design. METHODS:Patients attending a kidney care clinic (KCC) and at least one other specialty clinic of interest (DM, CVD) were randomly assigned to either the 'combined clinic (CC)' arm, where resources from all three were integrated into one clinic, or to the 'standard care' arm with continued attendance at multiple specialty clinics (MC), including the KCC. The primary outcome was hospitalization rate and sample size was calculated based on non-inferiority. RESULTS: Of 150 subjects enrolled, 11 subjects exited before study commencement: 139 remained for final analysis. Other than older age in the MC group (P = 0.009), the demographics were comparable. Hospitalization rates were not different (95% CI for the difference: 0.013-0.207; P = 0.03). Similar proportions in each group achieved clinical and laboratory targets. Mortality (13%) and dialysis (32%) rates were the same between groups. Differences in the cost of clinic visits alone were $86,400 per year in favor of the CC. CONCLUSIONS: Medical care of complex patients may be delivered in a single combined specialty clinic as compared to multiple disease specific clinics without compromising patient care or important health outcomes, with demonstrable outpatient costs savings.
Authors: Pim P Valentijn; Fernando Abdalla Pereira; Marinella Ruospo; Suetonia C Palmer; Jörgen Hegbrant; Christina W Sterner; Hubertus J M Vrijhoef; Dirk Ruwaard; Giovanni F M Strippoli Journal: Clin J Am Soc Nephrol Date: 2018-02-09 Impact factor: 8.237
Authors: Muhammad Rafiq; George Keel; Pamela Mazzocato; Jonas Spaak; Christian Guttmann; Peter Lindgren; Carl Savage Journal: J Multidiscip Healthc Date: 2019-12-24
Authors: Lisa Dubrofsky; Jason F Lee; Parisa Hajimirzarahimshirazi; Hongyan Liu; Alanna Weisman; Patrick R Lawler; Michael E Farkouh; Jacob A Udell; David Z Cherney Journal: Can J Kidney Health Dis Date: 2022-02-28
Authors: Chaim M Bell; Ron Wald; Samuel A Silver; Stuart L Goldstein; Ziv Harel; Andrea Harvey; Elizabeth J Rompies; Neill K Adhikari; Rey Acedillo; Arsh K Jain; Robert Richardson; Christopher T Chan; Glenn M Chertow Journal: Can J Kidney Health Dis Date: 2015-10-06