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A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control and self-care

A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control... ABSTRACTBackgroundCurrent healthcare models are ill-equipped for managing people with diabetes and chronic kidney disease (CKD). We evaluated the impact of a new diabetes and kidney disease service (DKS) on hospitalization, mortality, clinical and patient-relevant outcomes.MethodsLongitudinal analyses of adult patients with diabetes and CKD (Stages 3a–5) were performed using outpatient and hospitalization data from January 2015 to October 2018. Data were handled according to whether patients received the DKS intervention (n = 196) or standard care (n = 7511). The DKS provided patient-centred, coordinated multidisciplinary assessment and management of patients. Primary analyses examined hospitalization and mortality rates between the two groups. Secondary analyses evaluated the impact of the DKS on clinical target attainment, changes in estimated glomerular filtration rate (eGFR), glycated haemoglobin A1c (HbA1c), self-care and patient activation at 12 months.ResultsPatients who received the intervention had a higher hospitalization rate {incidence rate ratio [IRR] 1.20 [95% confidence interval (CI) 1.13–1.30]; P < 0.0001}, shorter median length of stay {2 days [interquartile range (IQR) 1–6] versus 4 days [IQR 1–9]; P < 0.0001} and lower all-cause mortality rate [IRR 0.4 (95% CI 0.29–0.64); P < 0.0001] than those who received standard care. Improvements in overall self-care [mean difference 2.26 (95% CI 0.83–3.69); P < 0.001] and in statin use and eye and feet examinations were observed. The mean eGFR did not change significantly after 12 months [mean difference 1.30 mL/min/1.73 m2 (95% CI −4.17–1.67); P = 0.40]. HbA1c levels significantly decreased by 0.40, 0.35, 0.34 and 0.23% at 3, 6, 9 and 12 months of follow-up, respectively.ConclusionsA co-designed, person-centred integrated model of care improved all-cause mortality, kidney function, glycaemic control and self-care for patients with diabetes and CKD. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Nephrology Dialysis Transplantation Oxford University Press

A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control and self-care

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References (48)

Publisher
Oxford University Press
Copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.
ISSN
0931-0509
eISSN
1460-2385
DOI
10.1093/ndt/gfab230
Publisher site
See Article on Publisher Site

Abstract

ABSTRACTBackgroundCurrent healthcare models are ill-equipped for managing people with diabetes and chronic kidney disease (CKD). We evaluated the impact of a new diabetes and kidney disease service (DKS) on hospitalization, mortality, clinical and patient-relevant outcomes.MethodsLongitudinal analyses of adult patients with diabetes and CKD (Stages 3a–5) were performed using outpatient and hospitalization data from January 2015 to October 2018. Data were handled according to whether patients received the DKS intervention (n = 196) or standard care (n = 7511). The DKS provided patient-centred, coordinated multidisciplinary assessment and management of patients. Primary analyses examined hospitalization and mortality rates between the two groups. Secondary analyses evaluated the impact of the DKS on clinical target attainment, changes in estimated glomerular filtration rate (eGFR), glycated haemoglobin A1c (HbA1c), self-care and patient activation at 12 months.ResultsPatients who received the intervention had a higher hospitalization rate {incidence rate ratio [IRR] 1.20 [95% confidence interval (CI) 1.13–1.30]; P < 0.0001}, shorter median length of stay {2 days [interquartile range (IQR) 1–6] versus 4 days [IQR 1–9]; P < 0.0001} and lower all-cause mortality rate [IRR 0.4 (95% CI 0.29–0.64); P < 0.0001] than those who received standard care. Improvements in overall self-care [mean difference 2.26 (95% CI 0.83–3.69); P < 0.001] and in statin use and eye and feet examinations were observed. The mean eGFR did not change significantly after 12 months [mean difference 1.30 mL/min/1.73 m2 (95% CI −4.17–1.67); P = 0.40]. HbA1c levels significantly decreased by 0.40, 0.35, 0.34 and 0.23% at 3, 6, 9 and 12 months of follow-up, respectively.ConclusionsA co-designed, person-centred integrated model of care improved all-cause mortality, kidney function, glycaemic control and self-care for patients with diabetes and CKD.

Journal

Nephrology Dialysis Transplantation – Oxford University Press

Published: Jul 26, 2021

Keywords: chronic kidney disease; diabetes; integrated care; patient activation; patient-centred care; self-care

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