SAT-201 PROACTIVE CASE MANAGEMENT MODEL FOR THE MULTIDISCIPLINARY CARE PROGRAM OF CHRONIC KIDNEY DISEASE

Abstract

According to the previous studies, patients who accept the multidiscipline care of chronic kidney disease have a significant effect for disease progression. In result, the patient-centered multidiscipline care program, focusing on CKD stage 3b, started in Taiwan since 2003. However, most of the patients enter this program in the fourth or even fifth stage of chronic kidney disease. "Proactive case management for multidiscipline care program" was established in our hospital since 2016 Not only application of case management for the patients with CKD but also screen the patients receiving medical services in our hospital and the propaganda for early referrals of CKD patients. In case, the patients with CKD could enter the care program in an earlier stage. The purpose of this study is to investigate whether the proactive management model of our hospital could enable patients to get early detection of disease and early access to multidiscipline care program. The study was conducted in a regional hospital retrospectively. The data of multidiscipline care program(pre-ESRD program) from January 2014 to September 2018 was analyzed. The patients who have eGFR > 45ml/min was excluded. As a result of the introduction of the "Proactive case management for the care program of chronic kidney disease" in April 2016, the patients who entered the pre-ESRD program before March 2016 were classified as a control group, while the patients after April 2016 were classified as a study group. We compared the implementation process of this care program and the related data about the two groups of patients. The eGFR was using the MDRD formula. The data was collected by the case manager in the hospital information system. We applicated statistical software STATA and use student T-test and regression analysis. P<0.05 was defined as significant. A total of 1,140 people were included. The control group had 449 patients, while the study group had 694 patients. The age of the control group and the study group were 70.89±0.58 and 69.07±0.48 (p=0.01), and there was no statistically significant difference between the two groups in sex, diabetes mellitus, hypertension, and smoking ratio. The initial eGFR of the control group and the study group were 25.94ml/min/m2 and 28.42 ml/min/m2, p<0.001. After multivariable regression with age, sex, diabetes mellitus, hypertension, and smoking ratio, the initial eGFR have a significant difference in the two groups(p<0.001). The initial eGFR value increased significantly after the introduction of proactive case management. It indicated that the patients could have early access to the pre-ESRD program after the introduction of the pro-active case management. In conclusion, the introduction of proactive case management model was related to the earlier access of the patients to the pre-ESRD program. In the future, this model should be applicable to other medical institutions and patients with chronic kidney disease can receive multidiscipline care earlier to improve the quality of care.