Impacto de la implementación de un modelo de gestión integral de atención de la enfermedad y cuidado coordinado en la población en diálisis en Colombia
Thesis
The end stage kidney disease has become epidemic with prevalence that has been increasing in a progressive way. The cost of treating the chronic kidney disease with dialysis doesn’t only depend on substitutive treatment but in handling the comorbidities and cardiovascular and infectious complications. The hospital care in the global cost of the patient’s treatment within dialysis is very high. Epidemiologic data published in recent years show the frequency of the events and number of hospital days of dialysis patients around the world. This study was made to evaluate subsequent results after the implementation of a disease management and coordinated care program in a dialysis network in Colombia, evaluating specific changes in a cohort of patients before and 2 years after de implementation. The program focuses basically in improving the treatment of dialysis patients by setting protocols in the management of comorbidities (e.g. diabetes, cardiovascular risk, infectious pathologies) and the coordinated care between ambulatory and hospital care. The design was an analytic observational study composed by two phases, a first retrospective historical cohort and a second phase with two prospective cohorts including prevalent patients. The study, showed important results in terms of significant improvement in HbA1c control in diabetic patients and reduction in the use of vascular catheters, also resulted in the reduction of hospitalization rates, hospital days per patient per year and mortality. The implementation of models as the one described could be a way to improve outcomes in dialysis patients and reduce the overall cost of care.
