Journal Article

Towards rational approaches of health care utilization in complex patients: an exploratory randomized trial comparing a novel combined clinic to multiple specialty clinics in patients with renal disease–cardiovascular disease–diabetes

Catherine Weber, Monica Beaulieu, Ognjenka Djurdjev, Lee Er, Paul Taylor, Andrew Ignaszewski, Shelley Burnett and Adeera Levin

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue suppl_3, pages iii104-iii110
Published in print October 2012 | ISSN: 0931-0509
Published online June 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr292
Towards rational approaches of health care utilization in complex patients: an exploratory randomized trial comparing a novel combined clinic to multiple specialty clinics in patients with renal disease–cardiovascular disease–diabetes

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Background

Optimal utilization of health care resources for patients with chronic conditions is an increasing focus of health care policy researchers and clinicians. Kidney disease, diabetes (DM) and cardiovascular disease (CVD) often coexist within one individual, but current systems are designed to manage individual conditions. We sought to examine if streamlining medical care of complex patients (two or more conditions) is associated with similar, worse or improved outcomes using a randomized controlled study design.

Methods

Patients attending a kidney care clinic (KCC) and at least one other specialty clinic of interest (DM, CVD) were randomly assigned to either the ‘combined clinic (CC)’ arm, where resources from all three were integrated into one clinic, or to the ‘standard care’ arm with continued attendance at multiple specialty clinics (MC), including the KCC. The primary outcome was hospitalization rate and sample size was calculated based on non-inferiority.

Results

Of 150 subjects enrolled, 11 subjects exited before study commencement: 139 remained for final analysis. Other than older age in the MC group (P = 0.009), the demographics were comparable. Hospitalization rates were not different (95% CI for the difference: 0.013–0.207; P = 0.03). Similar proportions in each group achieved clinical and laboratory targets. Mortality (13%) and dialysis (32%) rates were the same between groups. Differences in the cost of clinic visits alone were $86 400 per year in favor of the CC.

Conclusions

Medical care of complex patients may be delivered in a single combined specialty clinic as compared to multiple disease specific clinics without compromising patient care or important health outcomes, with demonstrable outpatient costs savings.

Keywords: chronic disease management; kidney disease; outcomes; randomized control trial; resource utilization

Journal Article.  3385 words.  Illustrated.

Subjects: Nephrology

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