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从全国范围的队列研究中检查慢性病患者的最佳多学科护理团队
Masanori Abe1,2, Tsuguru Hatta1,3, Yoshihiko Imamura1,4
1The Committee of the Evaluation and Dissemination for Certified Kidney Disease Educator, Japan Kidney Association.
Kidney research and clinical practice
|October 27, 2023
概括
基于多学科团队的综合护理 (MDC) 系统,由五名或更多专业人员组成,显著改善了慢性病 (CKD) 患者的功能,降低了慢性病患者的死亡风险. 这种方法显示出更好的CKD预后的希望.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 医疗保健管理的管理
背景情况:
- 建议对慢性病 (CKD) 患者提供基于多学科团队的综合护理 (MDC).
- 结构化的MDC系统尚未建立,需要研究最佳团队组成.
- 研究MDC对功能和预后的疗效至关重要.
研究的目的:
- 评估MDC系统在维持功能方面的有效性.
- 确定一个有效的MDC团队的最佳专业人员数量.
- 评估MDC对患者预后的影响,包括死亡率和置换疗法 (RRT).
主要方法:
- 一项全国性的多中心观察研究,从2015-2019年对2957名日本慢性病患者进行了观察.
- 根据MDC团队中专业人员的数量 (脏病学家+1-4+其他人) 将患者分组.
- 评估了估计的淋巴膜过率 (eGFR) 的变化,并使用了7年来对死亡率和RRT风险的Cox回归.
主要成果:
- 在所有组中,在MDC后的6,12和24个月观察到显著的eGFR改善 (p < 0.0001).
- 与只有科医生 (A组) (HR 0.60,p < 0.0001) 的团队相比,拥有五名或更多专业人员的团队 (D组) 显示,所有原因死亡率和RRT启动的风险降低了40% (HR 0.60,p < 0.0001).
- 这种益处在糖尿病和非糖尿病CKD亚组中是一致的.
结论:
- 一个由五名或更多专业人员组成的MDC团队可以改善慢性病患者的死亡率和预后.
- MDC证明了除了与糖尿病相关的CKD之外的有效性.
- 进一步研究优化慢性疾病管理的多学科团队结构是有必要的.
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