Abstract: SA-OR017

The Association between Participation in a Specialized Renal Disease Management Program and Economic Outcomes

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Chien, Changhung A, OptumHealth, Minneapolis, Minnesota, United States
  • Haig, Kael, OptumHealth, Minneapolis, Minnesota, United States
  • Ruyter, Matt, OptumHealth, Minneapolis, Minnesota, United States
  • Stankovic, Ana R., OptumHealth, Minneapolis, Minnesota, United States
Background

A 2016 meta-analysis of efficacy of chronic kidney-focused disease management (DM) programs demonstrated improved quality of life among chronic kidney disease (CKD) patients. However, published evaluations of DM program impact on medical spend, utilization, and transplantation have been inconsistent. We measured the association between participation in a specialized renal disease management (DM) program and all-cause medical spend, utilization outcomes, and transplantation among patients with Stage 4 or 5 CKD or ESRD.

Methods

The study included commercially insured members 18 years or older identified as having Stage 4 or 5 CKD or ESRD during January 2013 – December 2016. All members included in the study were eligible for the DM program. We compared members who participated in a nurse-based telephonic DM program (CKD = 1,428 and ESRD = 4,144) to members who did not participate in the DM program (CKD = 8,179 and ESRD = 5,825). Kaplan-Meier curves were used to estimate the probability of kidney transplant evaluation and transplant among CKD and ESRD patients. Chi-square and t-tests were used to compare differences in average inpatient admission rate, inpatient length of stay, and all-cause medical spend between DM program participants and non-participants.

Results

CKD patients who participated in the DM program were more likely to be evaluated for transplant than non-participants (25.8% vs. 7.1%) and to receive a preemptive transplant (4.8% vs. 1.5%). Similarly, ESRD patients who participated in the DM program were more likely to be evaluated for transplant than non-participants (32.5% vs. 4.5%) and also to receive a transplant (5.6% vs. 0.7%). ESRD program participants had fewer annual inpatient admissions (1.2 vs. 1.4) and fewer inpatient days per year (10.5 vs. 14.4) than non-participants. All reported differences were significant with p < 0.05. There were no significant differences in inpatient length of stay and all-cause medical expenditures between the study groups.

Conclusion

Participation in a specialized DM program was associated with higher transplant evaluation rate, higher preemptive and non-preemptive transplant rate, fewer inpatient admissions, and fewer inpatient days per year among patients with Stage 4 or 5 CKD or ESRD.

Funding

  • Commercial Support