[Healthcare management protocols for chronic stone disease (Kaiser Permanente).]
Domingo de Guzmán Ordaz Jurado1, Alberto Budía Alba1, Daniel López-Acón1
1Unidad de Litotricia y Endourología. Hospital Universitari i Politècnic La Fe de Valencia. España.
Insights
A Kaiser Permanente model effectively manages chronic stone disease, reducing recurrence by 42.2%. This approach improves patient outcomes and resource management for chronic conditions.
Area of Science:
- Nephrology
- Urology
- Healthcare Management
Background:
- Stone disease is a chronic condition with significant healthcare costs.
- Existing management strategies need adaptation for chronic disease care.
- The Kaiser Permanente model offers a framework for managing resource-intensive chronic diseases.
Purpose of the Study:
- To adapt and implement the Kaiser Permanente model for chronic stone disease management.
- To develop a risk stratification algorithm for patients with chronic stone disease.
- To evaluate the efficiency and patient satisfaction of the implemented model.
Main Methods:
- A three-phase project involving risk factor identification and a risk allocation model.
- Classification of patients into low, intermediate, and high-risk groups based on defined factors.
- Application of specific intervention measures tailored to patient risk levels.
Main Results:
- An algorithm and Kaiser pyramid were developed, stratifying 59% of patients as low-risk and 41% as high/very high-risk.
- A 42.2% reduction in global stone recurrence was observed compared to a control group over two years.
- High patient adherence (96.4%) and satisfaction (9.93/10) were reported.
Conclusions:
- The Kaiser Permanente model is a feasible approach for managing chronic stone disease.
- Preliminary findings indicate the model's effectiveness in improving outcomes for chronic stone disease patients.
Introduction:
Stone disease is a chronic condition in a high percentage of patients. Duento the high healthcare costs associated with the treatment of this pathology, chronicity approaches and strategies should be adapted and used in a similar way to other chronic diseases. One of the models applied for the management of these diseases with a significant impact on the consumption of health resources is the Kaiser Permanente model.
Material And Methods:
A chronic stone disease management project was developed and carried out in three different phases: Phase 1: identification of the target population of the program and design of the risk allocation model. The risk factors considered were CRG model (classification of risk groups or burden of morbidity) as a predictor of greater consumption of resources, anatomical risk factors, lithogenic risk factors, and hereditary factors associated with lithiasis. Phase 2: classification of patients according to risk and application of specific measures. The intervention measures will depend on the level of risk assigned: low, intermediate or high risk. Phase 3: analysis of indicators and results.
Results:
An algorithm of risk allocation was designed, and a Kaiser pyramid drawn. A total of 59% of the patients were assigned to the low-risk group and 41% corresponded to high-risk (36.5%) or very high-risk patients (4.5%). Preliminary results obtained at two years of follow-up show a reduction in global stone recurrence by 42.2% when compared with a control group (classic follow-up). The overall adherence of the intervention group was 96.4% and the satisfaction of the patients included in the program was 9.93/10.
Conclusions:
A management model for chronic stone disease based on the Kaiser Permanente pyramidis feasible. The implantation of this model has preliminarily demonstrated its efficiency in chronic patients.
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