The impact of Pre-ESRD program for diabetes patients
Date Issued
2014
Date
2014
Author(s)
Lee, Chien-Cheng
Abstract
Background and Objectives: Diabetes and chronic kidney disease (CKD) are the major cause of people into dialysis in Taiwan. In 2006, about 9,600 new patients into the dialysis treatment. Dialysis patients must be treated a kidney transplant or death from dialysis treatment. Although the number of kidney transplants each year is nearly 300 in Taiwan, kidney transplant is still lagging behind the speed to those entering dialysis. Early detection and early treatment to delay entering dialysis schedule and maintain quality of care is the world common goal today. Diabetes patients has exceeded 40% into dialysis treatment in Taiwan, Japan and the United States. Until 2010, dialysis ratio due to Diabetes was as high as 45.7% in Taiwan, highlighting the significant impact on the populations of diabetes prevention and treatment of chronic kidney disease. The purpose of this study is to evaluate patients with diabetes after joining the Pre-ESRD chronic kidney disease care program on medical use, medical costs and the entry time of dialysis.
Methods: This study adopted the NHI claim data from 2006 to 2011. The population is people joined the diabetes pay-for-performance project. These diabetes patients who joined Pre-ESRD chronic kidney disease care program were recruited as the intervention group and who never joined were control group. After using propensity score matching, the intervention and control groups are 1,980 people respectively, a total of 3,960 people. In this study, logistic regression and Generalized Estimating Equations(GEE) were applied to predict the influence and we use Difference-in-Difference(DID) method to evaluate the impact of the Pre-ESRD program by comparing the health care utilization and costs. Kaplan-Meier method to calculate survival curve, and Log-rank test were test for the differences between the two groups into the dialysis time.
Results: In health care utilization, the intervention group significantly increased on overall and nephrology-related physician visits. However, the hospitalization and length of stay were not significantly different. Total and outpatient medical costs significantly increased in intervention group. Inpatient medical costs was not significantly different after the intervention of Pre-ESRD chronic kidney disease care program. Results of survival analysis, the time of entry into dialysis was delayed in the intervention group.
Conclusions and Suggestions: The Pre-ESRD chronic kidney disease care program seemed to increase the outpatient medical utilization and health care costs, enhancing quality of health care and slow the case of kidney function deterioration. Suggested that the relevant authorities can establish patient-centered integrated care for diabetes and chronic kidney disease. Encouraging high-risk groups to participate in Pre-ESRD chronic kidney disease care program, to reduce the incidence of end-stage renal disease.
Subjects
糖尿病
慢性腎臟病
糖尿病給付改善方案
Pre-ESRD慢性腎臟病照護計畫
醫療利用
醫療費用
存活分析
SDGs
Type
thesis
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