Abstract
BackgroundInnovative care models such as public-private partnerships (PPPs) may help meet the challenge of providing cost-effective high-quality care for the steadily growing and complex chronic kidney disease population since they combine the expertise and efficiency of a specialized dialysis provider with the population care approach of a public entity. We report the five-years main clinical outcomes of a population of patients treated on hemodialysis within a PPP-care model in Italy.MethodsThis descriptive retrospective cohort study consisted of all consecutive hemodialysis patients treated in the NephroCare-operated Nephrology and Dialysis unit of the Seriate Hospital in 2012–2016, which exercises a PPP-care model. Clinical and treatment information was obtained from the European Clinical Database. Hospitalization outcomes and cumulative all-cause mortality incidences that accounted for competing risks were calculated.ResultsWe included 401 hemodialysis patients (197 prevalent and 204 incident patients) in our study. The mean cohort age and age-adjusted Charlson Comorbidity Index were 67.0 years and 6.7, respectively. Patients were treated with online high-volume hemodiafiltration or high-flux hemodialysis. Parameters of treatment efficiency were above the recommended targets throughout the study period. Patients in the PPP experienced benefits in terms of hospitalization (average number of hospital admissions/patient-year: 0.79 and 1.13 for prevalent and incident patients, respectively; average length of hospitalization: 8.9 days for both groups) and had low cumulative all-cause mortality rates (12 months: 10.6 and 7.8%, 5 years: 42.0 and 35.9%, for prevalent and incident patients, respectively).ConclusionsResults of our descriptive study suggest that hemodialysis patients treated within a PPP-care model framework received care complying with recommended treatment targets and may benefit in terms of hospitalization and mortality outcomes.
Highlights
Innovative care models such as public-private partnerships (PPPs) may help meet the challenge of providing cost-effective high-quality care for the steadily growing and complex chronic kidney disease population since they combine the expertise and efficiency of a specialized dialysis provider with the population care approach of a public entity
The PPP-model was initiated in 2010, our analyses focus on the study period 2012–2016 to ensure full implementation of NephroCares’ structures, processes and treatment guidelines and to reduce possible carryover effects from previous treatment policies
The groups were similar in terms of gender and comorbidity frequencies apart from diabetes mellitus, which was more common in incident patients (Table 1)
Summary
Innovative care models such as public-private partnerships (PPPs) may help meet the challenge of providing cost-effective high-quality care for the steadily growing and complex chronic kidney disease population since they combine the expertise and efficiency of a specialized dialysis provider with the population care approach of a public entity. Recent data show that the worldwide prevalence of chronic kidney disease (CKD) is 10–16% and is rising steadily. This places a significant economic burden on our healthcare systems because only < 1% of CKD patients progress to end-stage renal disease (ESRD), ESRD associates with high morbidity and mortality. Common comorbidities are cardiovascular disease, diabetes, anemia, and mineral and bone disease. Along with infections, these comorbidities are the main causes of hospital admission in ESRD. ESRD treatments account for 5% of the total annual healthcare budgets of countries globally [1,2,3,4,5]
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