Association of healthcare fragmentation and overall survival in patients with kidney transplant in Colombia

ObjectiveKidney transplantation requires a multidisciplinary approach to achieve optimal outcomes. Healthcare fragmentation can negatively impact clinical outcomes; however, this issue remains understudied in low- and middle-income countries (LMICs). This study aimed to assess healthcare fragmentation in kidney transplant patients during their first post-transplant year and evaluate its association with three-year survival among patients enrolled in Colombias contributory healthcare scheme. MethodsA retrospective cohort study was conducted using administrative data from Colombias contributory healthcare scheme. The cohort included kidney transplant recipients (2012-2016) who survived the first post-transplant year. Healthcare fragmentation was measured by the number of unique providers involved in the first year. Patients were categorised into high- and low-fragmentation groups based on the 75th percentile of provider distribution. The primary outcome was three-year survival, analysed using multivariate Cox regression to estimate hazard ratios (HRs), adjusted for age, sex, Charlson Comorbidity Index (CCI), insurer, region, and transplant year. ResultsThe cohort comprised 2,028 kidney transplant patients, with a mean age of 47.7 years (SD: 13.4), 38.7% female, and 68.7% presenting a CCI[≤]3. Healthcare fragmentation ranged from 1 to 34 providers, with a mean of 8.94 (SD: 6.77). High fragmentation ([≥]11 providers) was observed in 30.2% of patients. Three-year mortality was significantly higher in the high-fragmentation group (18%) compared to the low-fragmentation group (12%) (p=0.04). High fragmentation was associated with a 49% increased mortality risk (adjusted HR: 1.49; 95% CI: 1.12-1.97; p=0.01). ConclusionHealthcare fragmentation significantly reduces three-year overall survival in kidney transplant recipients in Colombia. These findings underscore the importance of integrated care models and improved coordination among providers to enhance patient outcomes, particularly in resource-limited settings.