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Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample

BACKGROUND: Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from: • Kidney Disease Improving Global Outcomes (KDIGO,2012) • National Insti...

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Autores principales: Kiel, Simone, Weckmann, Gesine, Chenot, Jean-François, Stracke, Sylvia, Spallek, Jacob, Angelow, Aniela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229756/
https://www.ncbi.nlm.nih.gov/pubmed/35751012
http://dx.doi.org/10.1186/s12882-022-02845-0
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author Kiel, Simone
Weckmann, Gesine
Chenot, Jean-François
Stracke, Sylvia
Spallek, Jacob
Angelow, Aniela
author_facet Kiel, Simone
Weckmann, Gesine
Chenot, Jean-François
Stracke, Sylvia
Spallek, Jacob
Angelow, Aniela
author_sort Kiel, Simone
collection PubMed
description BACKGROUND: Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from: • Kidney Disease Improving Global Outcomes (KDIGO,2012) • National Institute for Health and Care Excellence (NICE,2014) • German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015) • German College of General Practitioners and Family Physicians (DEGAM,2019) • Kidney failure risk equation (NICE,2021) METHODS: Data of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern. RESULTS: Data from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥ 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years. CONCLUSIONS: Applying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-022-02845-0.
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spelling pubmed-92297562022-06-25 Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample Kiel, Simone Weckmann, Gesine Chenot, Jean-François Stracke, Sylvia Spallek, Jacob Angelow, Aniela BMC Nephrol Research BACKGROUND: Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from: • Kidney Disease Improving Global Outcomes (KDIGO,2012) • National Institute for Health and Care Excellence (NICE,2014) • German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015) • German College of General Practitioners and Family Physicians (DEGAM,2019) • Kidney failure risk equation (NICE,2021) METHODS: Data of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern. RESULTS: Data from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥ 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years. CONCLUSIONS: Applying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-022-02845-0. BioMed Central 2022-06-24 /pmc/articles/PMC9229756/ /pubmed/35751012 http://dx.doi.org/10.1186/s12882-022-02845-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Kiel, Simone
Weckmann, Gesine
Chenot, Jean-François
Stracke, Sylvia
Spallek, Jacob
Angelow, Aniela
Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample
title Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample
title_full Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample
title_fullStr Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample
title_full_unstemmed Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample
title_short Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample
title_sort referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229756/
https://www.ncbi.nlm.nih.gov/pubmed/35751012
http://dx.doi.org/10.1186/s12882-022-02845-0
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