Healthcare Resource Consumption And Costs Before And After Kidney Transplantation In Lombardy, Italy

Abstract Background Medical costs and the burden associated with cardiovascular disease are on the rise. Therefore, to improve the overall economy and quality assessment of the healthcare system, we developed a predictive model of integrated healthcare resource consumption (Adherence Score for Healthcare Resource Outcome, ASHRO) that incorporates patient health behaviours, and examined its association with clinical outcomes. Methods This study used information from a large-scale database on health insurance claims, long-term care insurance, and health check-ups. Participants comprised patients who received inpatient medical care for diseases of the circulatory system (ICD-10 codes I00-I99). The predictive model used broadly defined composite adherence as the explanatory variable and medical and long-term care costs as the objective variable. Predictive models used random forest learning (AI: artificial intelligence) to adjust for predictors, and multiple regression analysis to construct ASHRO scores. The ability of discrimination and calibration of the prediction model were evaluated using the area under the curve and the Hosmer-Lemeshow test. We compared the overall mortality of the two ASHRO 50% cut-off groups adjusted for clinical risk factors by propensity score matching over a 48-month follow-up period. Results Overall, 48,456 patients were discharged from the hospital with cardiovascular disease (mean age, 68.3 ± 9.9 years; male, 61.9%). The broad adherence score classification, adjusted as an index of the predictive model by machine learning, was an index of eight: secondary prevention, rehabilitation intensity, guidance, proportion of days covered, overlapping outpatient visits/clinical laboratory and physiological tests, medical attendance, and generic drug rate. Multiple regression analysis showed an overall coefficient of determination of 0.313 (p < 0.001). Logistic regression analysis with cut-off values of 50% and 25%/75% for medical and long-term care costs showed that the overall coefficient of determination was statistically significant (p < 0.001). The score of ASHRO was associated with the incidence of all deaths between the two 50% cut-off groups (2% vs. 7%; p < 0.001). Conclusions ASHRO accurately predicted future integrated healthcare resource consumption and was associated with clinical outcomes. It can be a valuable tool for evaluating the economic usefulness of individual adherence behaviours and optimising clinical outcomes.

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The Effects of Information and Support on Individuals Awaiting Cadaveric Kidney Transplantation

Progress in Transplantation ◽

10.1177/152692480201200308 ◽

2002 ◽

Vol 12 (3) ◽

pp. 201-207 ◽

Cited By ~ 2

Author(s):

Cynthia L. Russell ◽

Kristi Brown

Keyword(s):

Kidney Transplantation ◽

Treatment Group ◽

Nursing Intervention ◽

Control Group ◽

Body Of Knowledge ◽

Phone Calls ◽

Growing Body ◽

Before And After ◽

Cadaveric Kidney ◽

Cadaveric Kidney Transplantation

Context No empirical studies exist to direct nursing interventions for individuals during the long period of waiting for a transplant. Objective To measure the effect of information and support on hope and uncertainty for individuals awaiting cadaveric kidney transplantation. Design Randomized, controlled study. Setting A university-affiliated hospital in the Midwest from 1997 to 1999. Patients Fifty participants awaiting cadaveric kidney transplantation. Interventions The control group received no intervention phone calls or mailings, which was the current standard of care. The treatment group received phone calls and mailings once every month for 6 months. Main Outcome Measures Hope, measured by the Herth Hope Index, and uncertainty, measured by the Mishel's Uncertainty in Illness Scale for Adults, were evaluated at the beginning of the study and 6 months later. Results No statistically significant effect of the nursing intervention was found on hope and uncertainty in this sample (F = 0.5322, P = .81). Hope was found to be negatively related to uncertainty both before ( r = $0.53, P = .0001) and after ( r = $0.59, P = .0001) intervention. No significant change was found between hope before and after intervention, and uncertainty before and after intervention in the treatment group (F = 1.10, P = .40) or the control group. Conclusion The individuals indicated that definite needs were met by the information and support intervention even though the results did not statistically support the effect of the nursing intervention. Conclusions Several conclusions can be drawn from the findings of this study. First, even though the nursing intervention of providing information and support did not have a statistically significant effect on levels of hope and uncertainty in individuals awaiting kidney transplantation, anecdotal reports from the respondents indicated that the phone calls and mailed information were helpful and appreciated. Valuable information, potentially impacting the outcomes of kidney transplantation, was gathered by the researchers and shared with the transplant team. Secondly, levels of hope were relatively high, whereas levels of uncertainty were moderate in this sample of individuals waiting for cadaveric kidney transplantation. Furthermore, in this sample, the average time since diagnosis of ESRD was more than 4 years and the average waiting time was more than 1 year. There may have been a change over time from viewing the waiting experience as a negative experience to a positive opportunity. Thirdly, the finding of a negative relationship between hope and uncertainty provided support to the growing body of knowledge of this association. Finally, time on the waiting list, gender, and marital status were not associated with levels of hope or uncertainty. Generally, the findings of this study are consistent with existing literature and add to the growing body of knowledge related to the midrange theories of hope and uncertainty.

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Analysis of the physical aspects of quality of life of kidney recipients

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-623420150000100010 ◽

2015 ◽

Vol 49 (1) ◽

pp. 76-81 ◽

Cited By ~ 3

Author(s):

Ana Elza Oliveira de Mendonça ◽

Marina de Góes Salvetti ◽

Eulália Maria Chaves Maia ◽

Ana Cristina de Oliveira e Silva ◽

Gilson de Vasconcelos Torres

Keyword(s):

Quality Of Life ◽

Kidney Transplantation ◽

Kidney Transplant ◽

World Health ◽

Need For Treatment ◽

Kidney Recipients ◽

Quality Of Life Scale ◽

Before And After ◽

Health Organization

OBJECTIVE To identify the main factors of the physical domain modified after kidney transplantation and analyze the influence of those aspects in the perception of Overall quality of life (QOL). METHOD Longitudinal study, conducted with 63 chronic kidney patients, evaluated before and after kidney transplant, using the quality of life scale proposed by the World Health Organization. RESULTS We observed significant improvement in the physical aspects of QOL after kidney transplantation. Significant correlations were observed between physical aspects and the Overall QOL. CONCLUSION The kidney transplant generated improvement in all physical aspects of QOL. The factors that showed stronger correlation with the Overall QOL before the transplant were the capacity to work and pain. After the transplant, the perception of need for treatment was the factor that showed stronger correlation with the Overall QOL.

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Sexuality and Pregnancy Before and After Kidney Transplantation

Kidney Transplantation: A Guide to the Care of Kidney Transplant Recipients ◽

10.1007/978-1-4419-1690-7_20 ◽

2010 ◽

pp. 343-354

Author(s):

Martha Pavlakis ◽

Dianne B. McKay

Keyword(s):

Kidney Transplantation ◽

Before And After

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Association between adiponectin and insulin resistance in Egyptian patients with end-stage renal disease before and after kidney transplantation

Al-Azhar Assiut Medical Journal ◽

10.4103/azmj.azmj_6_20 ◽

2020 ◽

Vol 18 (4) ◽

pp. 453

Author(s):

DinaM Abaza ◽

AhmedE.S El Boghdady ◽

MervatE.S El Wakeel ◽

KhaledM Ewada ◽

HishamA El Bardissy

Keyword(s):

Insulin Resistance ◽

Kidney Transplantation ◽

Renal Disease ◽

End Stage Renal Disease ◽

Egyptian Patients ◽

Before And After ◽

Stage Renal Disease ◽

End Stage

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OP64 Economic Impact Of Cardiac Device Remote Monitoring In South Korea

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001477 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 28-28

Author(s):

Jeonghoon Ahn ◽

Kim Eung Ju ◽

Justin Yoo ◽

Irene Colangelo ◽

Loredana Morichelli ◽

...

Keyword(s):

South Korea ◽

Remote Monitoring ◽

Healthcare Costs ◽

Healthcare Resource ◽

Economic Benefits ◽

Resource Consumption ◽

Healthcare Payer ◽

The South ◽

South Korean

INTRODUCTION:The reduction of healthcare costs and societal cost due to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been demonstrated in several countries; however, to the best of our knowledge it does not exist for South Korea. This work aims at providing an estimation of the potential benefit of RM versus standard care (SC) of CIEDs in term of healthcare costs in South Korea, in order to provide additional substance to the currently ongoing societal debate about the value of telemedicine.METHODS:Healthcare resource consumption was taken from the results of the TARIFF study, a prospective, non-randomized, multicenter clinical trial designed in Italy to assess the economic benefits of RM follow-up in comparison with standard follow-up in 209 patients (107 SC, 102 RM). The main results demonstrated that RM reduced healthcare resource consumption by 54 percent from a healthcare services perspective (SC: EUR1,044.89±1,990.47 versus RM: EUR482.87±2488.10, p<.0001 (1).In order to perform a cost analysis from the perspective of the South Korean healthcare payer, the following unit costs were assigned to resources collected in TARIFF (hospitalizations, visits, examinations): fee-for-service tariffs, emergency tariffs and outpatient tariffs. Remote follow-up costs were considered as zero.RESULTS:From the perspective of the South Korean healthcare payer, the overall mean annual cost/patient in the RM group is 53 percent lower than in SC group (SC: EUR405,439±40,135 versus RM: EUR189,96±725,52, p<.0001) (SC: KRW 497,145±49,2137 versus RM: KRW 232,936±890,181, p<.0001). This is mainly due to a significant cost reduction in device-related hospitalizations, examination tests and visits in the follow-up period.CONCLUSIONS:RM of CIED patients is cost-saving from the perspective of the South Korean healthcare system. Introducing appropriate reimbursement for remote monitoring of CIED is not likely to change this result and should make RM sustainable for the provider and encourage widespread adoption of RM.

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