Managing comorbidities in chronic kidney disease reduces utilization and costs
Abstract Background Effective management of comorbid diabetes and hypertension in patients with chronic kidney disease (CKD) is important for optimal outcomes. However, little is known about this relationship from a health plan perspective. The objective of this study was to evaluate the association...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-023-10424-8 |
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| author | Yong Li Kanchan Barve Meghan Cockrell Amal Agarwal Adrianne Casebeer Suzanne W. Dixon Insiya Poonawalla |
| author_facet | Yong Li Kanchan Barve Meghan Cockrell Amal Agarwal Adrianne Casebeer Suzanne W. Dixon Insiya Poonawalla |
| author_sort | Yong Li |
| collection | DOAJ |
| description | Abstract Background Effective management of comorbid diabetes and hypertension in patients with chronic kidney disease (CKD) is important for optimal outcomes. However, little is known about this relationship from a health plan perspective. The objective of this study was to evaluate the association of effective management of comorbid diabetes and/or hypertension with healthcare resource utilization (HCRU) in patients with chronic kidney disease (CKD). Methods This retrospective cohort study used the Humana Research Database to identify patients with CKD Stage ≥ 3a in 2017. Eligible patients were enrolled in a Medicare Advantage Prescription Drug plan for ≥ 12 months before and after the index date (first observed evidence of CKD). Patients with end-stage renal disease, kidney transplant, or hospice election preindex were excluded. Recommended comorbid disease management included hemoglobin A1c monitoring; adherence to glucose-lowering, cardiovascular, and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker medications; and nephrologist/primary care provider (PCP) visits. HCRU was evaluated for 12 months postindex. Results The final cohort of 241,628 patients was 55% female and 77% White, with an average age of 75 years. Approximately 90% of patients had Stage 3 CKD. Half had both diabetes and hypertension, and most of the remaining half had hypertension without diabetes. Patients meeting the criteria for good disease management, compared with patients not meeting those criteria, were less likely to experience an inpatient hospitalization, by as much as 40% depending on the criterion and the comorbidities present, or an emergency department visit, by as much as 30%. Total monthly healthcare costs were as much as 17% lower. Conclusions Management of comorbid diabetes and hypertension in patients with CKD was associated with lower HCRU and costs. Care coordination programs targeting patients with CKD must give careful attention to glucose and blood pressure control. Trial registration Not applicable. |
| first_indexed | 2024-03-08T22:40:32Z |
| format | Article |
| id | doaj.art-8fa5293cb43f4897a970e6b2d5d8ecba |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-08T22:40:32Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-8fa5293cb43f4897a970e6b2d5d8ecba2023-12-17T12:11:22ZengBMCBMC Health Services Research1472-69632023-12-012311910.1186/s12913-023-10424-8Managing comorbidities in chronic kidney disease reduces utilization and costsYong Li0Kanchan Barve1Meghan Cockrell2Amal Agarwal3Adrianne Casebeer4Suzanne W. Dixon5Insiya Poonawalla6Humana Healthcare Research, Humana IncHumana IncHumana IncAffiliated with Humana at the Time of the Work, Current Affiliation Monogram HealthHumana IncHumana Healthcare Research, Humana IncHumana Healthcare Research, Humana IncAbstract Background Effective management of comorbid diabetes and hypertension in patients with chronic kidney disease (CKD) is important for optimal outcomes. However, little is known about this relationship from a health plan perspective. The objective of this study was to evaluate the association of effective management of comorbid diabetes and/or hypertension with healthcare resource utilization (HCRU) in patients with chronic kidney disease (CKD). Methods This retrospective cohort study used the Humana Research Database to identify patients with CKD Stage ≥ 3a in 2017. Eligible patients were enrolled in a Medicare Advantage Prescription Drug plan for ≥ 12 months before and after the index date (first observed evidence of CKD). Patients with end-stage renal disease, kidney transplant, or hospice election preindex were excluded. Recommended comorbid disease management included hemoglobin A1c monitoring; adherence to glucose-lowering, cardiovascular, and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker medications; and nephrologist/primary care provider (PCP) visits. HCRU was evaluated for 12 months postindex. Results The final cohort of 241,628 patients was 55% female and 77% White, with an average age of 75 years. Approximately 90% of patients had Stage 3 CKD. Half had both diabetes and hypertension, and most of the remaining half had hypertension without diabetes. Patients meeting the criteria for good disease management, compared with patients not meeting those criteria, were less likely to experience an inpatient hospitalization, by as much as 40% depending on the criterion and the comorbidities present, or an emergency department visit, by as much as 30%. Total monthly healthcare costs were as much as 17% lower. Conclusions Management of comorbid diabetes and hypertension in patients with CKD was associated with lower HCRU and costs. Care coordination programs targeting patients with CKD must give careful attention to glucose and blood pressure control. Trial registration Not applicable.https://doi.org/10.1186/s12913-023-10424-8Chronic kidney diseaseHealthcare resource utilizationDiabetes careHypertensionCare coordinationManaged care |
| spellingShingle | Yong Li Kanchan Barve Meghan Cockrell Amal Agarwal Adrianne Casebeer Suzanne W. Dixon Insiya Poonawalla Managing comorbidities in chronic kidney disease reduces utilization and costs BMC Health Services Research Chronic kidney disease Healthcare resource utilization Diabetes care Hypertension Care coordination Managed care |
| title | Managing comorbidities in chronic kidney disease reduces utilization and costs |
| title_full | Managing comorbidities in chronic kidney disease reduces utilization and costs |
| title_fullStr | Managing comorbidities in chronic kidney disease reduces utilization and costs |
| title_full_unstemmed | Managing comorbidities in chronic kidney disease reduces utilization and costs |
| title_short | Managing comorbidities in chronic kidney disease reduces utilization and costs |
| title_sort | managing comorbidities in chronic kidney disease reduces utilization and costs |
| topic | Chronic kidney disease Healthcare resource utilization Diabetes care Hypertension Care coordination Managed care |
| url | https://doi.org/10.1186/s12913-023-10424-8 |
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