A System-Wide Population Health Value Approach to Reduce Hospitalization Among Chronic Kidney Disease Patients: an...

Area of Science:

• Nephrology
• Healthcare Management
• Public Health

Background:

• Chronic kidney disease (CKD) presents significant healthcare burdens, including high morbidity, utilization, and costs.
• Managing late-stage CKD populations is complex and resource-intensive.
• Improving healthcare system efficiency is crucial for mitigating CKD outcomes and reducing exposure risks during health crises like COVID-19.

Purpose of the Study:

• To evaluate a novel patient-centered intervention designed to decrease inpatient utilization among CKD patients.
• To assess the impact of a system-wide transformation aimed at improving healthcare value for high-utilization populations.

Main Methods:

• An interrupted time series regression analysis was conducted over 18 months pre-intervention and 12 months post-intervention.
• Data from internal electronic health records and claims across six payers were utilized.
• The study included 1442 patients with stage 4-5 CKD at a major academic medical center.

Main Results:

• Following intervention, hospitalizations declined at a monthly rate of 5.4%, a statistically significant acceleration compared to the pre-intervention rate (p=0.004).
• Emergency department (ED) visits for Medicare CKD patients declined by 3.0% monthly post-intervention, significantly faster than the pre-intervention rate (p=0.02).
• The intervention involved risk stratification, redesigned multispecialty care pathways, and enhanced ambulatory infrastructure.

Conclusions:

• Establishing integrated care pathways linking primary and specialty care teams across settings can effectively reduce inpatient healthcare utilization.
• Enhanced ambulatory infrastructure is key to supporting care needs and improving efficiency for CKD populations.
• This patient-centered approach demonstrates potential for significant healthcare system improvements in managing chronic diseases.