N04 N17.9 N18.1 N18.2 N18.3 N18.4 N18.5 N19 R31 R80
Conditions
Interventions
Group 1: Risk-based discharge management, consisting of the calculation of the 5-year risk of kidney failure (ESRD) by the Kidney Failure Risk Equation (KFRE) and an appointment with a specialist for
Sponsors
KfH-Stiftung Präventivmedizin,
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: - Health insurance with KNAPPSCHAFT - Admission to one of the participating hospitals from 20 September 2022 - Existing chronic renal insufficiency (either already known and documented in the KIS by diagnoses such as N17.99 or N18.1-.9, N19, R31, R80) or detected during hospitalization (<60 ml/min/1.73 m² according to CKD-Epi, as opposed to acute renal failure) - Risk of end-stage renal failure within 5 years according to the KFRE score of at least 15% (date of laboratory determination before 20.06.2023) or at least 9% (from 20.06.2023) - Consent to be contacted after dismissal and to contact the HA/HÄ and the FA/FA
Exclusion criteria
Exclusion criteria: - Patients with = 2 consultations with a nephrological specialist in the last 12 months before enrollment - Included in MinDial during previous hospital stay - Pregnancy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Difference (ml/min/1.73 m²) in the decrease of the eGFR according to CKD-Epi (Levey 2009), comparing intervention and control groups after 12 months from discharge | — |
Secondary
| Measure | Time frame |
|---|---|
| Comparison parameters between K and I patients: • Difference in the proportion (%) of patients with controlled blood pressure (= 140/90 mm Hg). If more than one blood pressure measurement is available, its average value is included in the evaluation. • In diabetics: Difference in proportion (%) with guideline-compliant HbA1c (6.5 – = 7.5%) • Difference in the proportion (%) of patients with non-guideline care with regard to the prescription of selected medication groups (including statins, RAS blockers, ARB, ACEI; based on pre-specified ATC codes classified as non- guideline-compliant) according to assessment of medication plans by consultant nephrologists • Difference in the proportion (%) of patients with non-guideline medication • Difference in mortality rate (%) Health economics: • Intervention costs and costs of medical service utilization in relation to primary and secondary endpoints in the context of cost-effectiveness analyses Assessment of process quality: The process quality of the intervention is assessed by the assessment of the intervention patients as well as by the assessment of the HA and nephological FA. The patient's assessment is collected after 3 and 12 months. a) Comparison between intervention and control group: • Difference in proportion (%) with a nephrology specialist consultation after 3 months from discharge (b) Intervention patients: • Perceived quality of care (PRO, 3+12 months), after 3 months including factors from the patient's point of view that have led to non-use of nephologic care • Subjective disease concept (PRO: BIPQ, 3+12 months) • Knowledge of kidney disease (PRO: PIKS, 3+12 months) • Health-related quality of life (PRO: SF12, 3+12 months) (c) Control patients: • Subjective disease concept (PRO: BIPQ, 12 months) • Knowledge of kidney disease (PRO: PIKS, 12 months) • Health-related quality of life (PRO: SF12, 12 months) d) General practitioners/speciali | — |
Countries
Germany
Outcome results
None listed