An outpatient integrated management program reduced the need for hospitalizations of CKD patients: findings from the PIRP project

Background and hypothesisIn patients with moderate or severe renal disease, hospitalization is often required because of poorly controlled co-morbidities. We aimed to provide evidence that an outpatient health program involving a close collaboration between nephrologists and General Practitioners can be successful in reducing hospitalizations in non-dialysis chronic kidney disease patients. MethodsObservational cohort study on 17,036 stage 1-5 chronic kidney disease patients enrolled in the Emilia-Romagna (Italy) PIRP project between 1st April 2004 and 31st December 2015, and their 70,560 hospitalizations registered in the four years preceding and following their enrolment in the project. Interrupted Time Series analysis was used to estimate hospitalizations trend summarized on 4-monthly basis. ResultsAmong patients who survived 4 years in non-dialysis chronic kidney disease condition, a 2.9% reduction in hospitalizations was observed in the four years following the enrolment in PIRP compared to the four years previously. The change in hospitalizations trend was estimated at -8.09 admission per 1,000 patients and 4-month period. This decrease was mainly accountable to hospitalizations whose main diagnoses at discharge were diseases of the circulatory system and the genitourinary system (-2.68 and -4.76 admissions per 1,000 patients respectively). Patients with heart failure and those with coronary artery disease displayed large reductions in hospitalization trend (-17.08 and -9.48 admissions per 1,000 patients respectively). A reduction of hospitalizations with similar magnitude was also observed for the advanced stages of CKD. ConclusionThe implementation of an integrated public health project that provides for the early management and continuity of care of CKD patients may be a way to reduce hospitalizations, particularly those related to cardiovascular and genitourinary diagnoses. Key learning pointsO_ST_ABSWhat was knownC_ST_ABSWith an integrated and structured program based on the collaboration between nephrologists and General Practitioners, it is possible to better control progression and comorbidity in CKD. This study addsBy continuously following CKD patients with a close collaboration between nephrologists and General Practitioners, hospitalizations can be reduced. Potential impactThe implementation of an integrated model of outpatient management of CKD patients like the PIRP might be beneficial also on hospitals organization and costs, and ultimately on patients quality of life. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=123 SRC="FIGDIR/small/25322544v1_ufig1.gif" ALT="Figure 1"> View larger version (50K): org.highwire.dtl.DTLVardef@8d63cforg.highwire.dtl.DTLVardef@93c911org.highwire.dtl.DTLVardef@7587b2org.highwire.dtl.DTLVardef@1fbe88_HPS_FORMAT_FIGEXP M_FIG C_FIG