TY - JOUR
T1 - A System-Wide Population Health Value Approach to Reduce Hospitalization Among Chronic Kidney Disease Patients
T2 - an Observational Study
AU - Gupta, R.
AU - Skootsky, S. A.
AU - Kahn, K. L.
AU - Chen, L.
AU - Abtin, F.
AU - Kee, S.
AU - Nicholas, S. B.
AU - Vangala, S.
AU - Wilson, J.
N1 - Publisher Copyright:
© 2020, Society of General Internal Medicine.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020
Y1 - 2020
N2 - Background: Chronic kidney disease (CKD) is a leading cause of healthcare morbidity, utilization, and expenditures nationally, and caring for late-stage CKD populations is complex. Improving health system efficiency could mitigate these outcomes and, in the COVID-19 era, reduce risks of viral exposure. Objective: As part of a system-wide transformation to improve healthcare value among populations with high healthcare utilization and morbidity, UCLA Health evaluated a new patient-centered approach that we hypothesized would reduce inpatient utilization for CKD patients. Design: For 18 months in 2015–2016 and 12 months in 2017, we conducted an interrupted time series regression analysis to evaluate the intervention’s impact on inpatient utilization. We used internal electronic health records and claims data across six payers. Participants: A total of 1442 stage 4–5 CKD patients at a large academic medical center. Intervention: Between October and December 2016, the organization implemented a Population Health Value CKD intervention for the CKD stages 4–5 population. A multispecialty leadership team risk stratified the population and identified improvement opportunities, redesigned multispecialty care coordination pathways across settings, and developed greater ambulatory infrastructure to support care needs. Main Measures: Outcomes included utilization of hospitalizations, emergency department (ED) visits, inpatient bed days, and 30-day all-cause readmissions. Key Results: During the 12 months following intervention implementation, the monthly estimated rate of decline for hospitalizations was 5.4% (95% CI: 3.4–7.4%), which was 3.4 percentage points faster than the 18-month pre-intervention decline of 2.0% (95% CI: 1.0–2.2%) per month (p = 0.004). Medicare CKD patients’ monthly ED visit rate of decline was 3.0% (95% CI: 1.2–4.8%) after intervention, which was 2.6 percentage points faster than the pre-intervention decline of 0.4% (95% CI: − 0.8 to 1.6%) per month (p = 0.02). Conclusions: By creating care pathways that link primary and specialty care teams across settings with increased ambulatory infrastructure, healthcare systems have potential to reduce inpatient healthcare utilization.
AB - Background: Chronic kidney disease (CKD) is a leading cause of healthcare morbidity, utilization, and expenditures nationally, and caring for late-stage CKD populations is complex. Improving health system efficiency could mitigate these outcomes and, in the COVID-19 era, reduce risks of viral exposure. Objective: As part of a system-wide transformation to improve healthcare value among populations with high healthcare utilization and morbidity, UCLA Health evaluated a new patient-centered approach that we hypothesized would reduce inpatient utilization for CKD patients. Design: For 18 months in 2015–2016 and 12 months in 2017, we conducted an interrupted time series regression analysis to evaluate the intervention’s impact on inpatient utilization. We used internal electronic health records and claims data across six payers. Participants: A total of 1442 stage 4–5 CKD patients at a large academic medical center. Intervention: Between October and December 2016, the organization implemented a Population Health Value CKD intervention for the CKD stages 4–5 population. A multispecialty leadership team risk stratified the population and identified improvement opportunities, redesigned multispecialty care coordination pathways across settings, and developed greater ambulatory infrastructure to support care needs. Main Measures: Outcomes included utilization of hospitalizations, emergency department (ED) visits, inpatient bed days, and 30-day all-cause readmissions. Key Results: During the 12 months following intervention implementation, the monthly estimated rate of decline for hospitalizations was 5.4% (95% CI: 3.4–7.4%), which was 3.4 percentage points faster than the 18-month pre-intervention decline of 2.0% (95% CI: 1.0–2.2%) per month (p = 0.004). Medicare CKD patients’ monthly ED visit rate of decline was 3.0% (95% CI: 1.2–4.8%) after intervention, which was 2.6 percentage points faster than the pre-intervention decline of 0.4% (95% CI: − 0.8 to 1.6%) per month (p = 0.02). Conclusions: By creating care pathways that link primary and specialty care teams across settings with increased ambulatory infrastructure, healthcare systems have potential to reduce inpatient healthcare utilization.
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U2 - 10.1007/s11606-020-06272-5
DO - 10.1007/s11606-020-06272-5
M3 - Article
C2 - 33140277
AN - SCOPUS:85094926630
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
ER -