PURPOSE: Though case management has been recommended to improve the outcomes of patients with costly or morbid conditions, it has seldom been studied in controlled trials. We performed a randomized, controlled clinical trial of an intensive, multidisciplinary case management program for patients with chronic renal insufficiency and followed patients for 5 years. PATIENTS AND METHODS: We enrolled 437 primary-care patients (73% of those eligible) with chronic renal insufficiency (estimated creatinine clearance consistently <; 50 mL/min with the last serum creatinine level > 1.4 mg/dL) who were attending an urban academic general internal medicine practice. The intensive case management, administered during the first 2 years after enrollment, consisted of mandatory repeated consultations in a nephrology case management clinic staffed by two nephrologists, a renal nurse, a renal dietitian, and a social worker. Control patients received usual care. Primary outcome measurements included serum creatinine level, estimated creatinine clearance, health services use, and mortality in the 5 years after enrollment. Secondary measures included use of renal sparing and potentially nephrotoxic drugs. RESULTS: There were no differences in renal function, health services use, or mortality in the first, second, or third through fifth years after enrollment. There were significantly more outpatient visits among intervention patients, mainly because of the added visits to the nephrology case management clinic. There were also no significant differences in the use of renal sparing or selected potentially nephrotoxic drugs. The annual direct costs of the intervention were $89,355 ($484 per intervention patient). CONCLUSION: This intensive, multidisciplinary case-management intervention had no effect on the outcomes of care among primary-care patients with established chronic renal insufficiency. Such expensive and intrusive interventions, despite representing state-of-the-art care, should be tested prospectively before being widely introduced into practice.
RCT Entities:
PURPOSE: Though case management has been recommended to improve the outcomes of patients with costly or morbid conditions, it has seldom been studied in controlled trials. We performed a randomized, controlled clinical trial of an intensive, multidisciplinary case management program for patients with chronic renal insufficiency and followed patients for 5 years. PATIENTS AND METHODS: We enrolled 437 primary-care patients (73% of those eligible) with chronic renal insufficiency (estimated creatinine clearance consistently < 50 mL/min with the last serum creatinine level > 1.4 mg/dL) who were attending an urban academic general internal medicine practice. The intensive case management, administered during the first 2 years after enrollment, consisted of mandatory repeated consultations in a nephrology case management clinic staffed by two nephrologists, a renal nurse, a renal dietitian, and a social worker. Control patients received usual care. Primary outcome measurements included serum creatinine level, estimated creatinine clearance, health services use, and mortality in the 5 years after enrollment. Secondary measures included use of renal sparing and potentially nephrotoxic drugs. RESULTS: There were no differences in renal function, health services use, or mortality in the first, second, or third through fifth years after enrollment. There were significantly more outpatient visits among intervention patients, mainly because of the added visits to the nephrology case management clinic. There were also no significant differences in the use of renal sparing or selected potentially nephrotoxic drugs. The annual direct costs of the intervention were $89,355 ($484 per intervention patient). CONCLUSION: This intensive, multidisciplinary case-management intervention had no effect on the outcomes of care among primary-care patients with established chronic renal insufficiency. Such expensive and intrusive interventions, despite representing state-of-the-art care, should be tested prospectively before being widely introduced into practice.
Authors: Elizabeth A Bayliss; Bharati Bhardwaja; Colleen Ross; Arne Beck; Diane M Lanese Journal: Clin J Am Soc Nephrol Date: 2011-01-27 Impact factor: 8.237
Authors: E L J Hoogervorst; P de Jonge; B Jelles; F J Huyse; I Heeres; H M van der Ploeg; B M J Uitdehaag; C H Polman Journal: J Neurol Neurosurg Psychiatry Date: 2003-01 Impact factor: 10.154
Authors: Ping Liu; Robert R Quinn; Mohammad Ehsanul Karim; Aminu Bello; Helen Tam-Tham; Robert Weaver; Paul E Ronksley; Hude Quan; Giovanni F M Strippoli; Braden Manns; Brenda R Hemmelgarn; Marcello Tonelli; Pietro Ravani Journal: CMAJ Date: 2019-03-11 Impact factor: 8.262
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: William M Tierney; J Marc Overhage; Michael D Murray; Lisa E Harris; Xiao-Hua Zhou; George J Eckert; Faye E Smith; Nancy Nienaber; Clement J McDonald; Fredric D Wolinsky Journal: Health Serv Res Date: 2005-04 Impact factor: 3.402
Authors: William M Tierney; J Marc Overhage; Michael D Murray; Lisa E Harris; Xiao-Hua Zhou; George J Eckert; Faye E Smith; Nancy Nienaber; Clement J McDonald; Fredric D Wolinsky Journal: J Gen Intern Med Date: 2003-12 Impact factor: 5.128
Authors: Scott R Weingarten; James M Henning; Enkhe Badamgarav; Kevin Knight; Vic Hasselblad; Anacleto Gano; Joshua J Ofman Journal: BMJ Date: 2002-10-26
Authors: Mary Catherine Beach; Tiffany L Gary; Eboni G Price; Karen Robinson; Aysegul Gozu; Ana Palacio; Carole Smarth; Mollie Jenckes; Carolyn Feuerstein; Eric B Bass; Neil R Powe; Lisa A Cooper Journal: BMC Public Health Date: 2006-04-24 Impact factor: 3.295