Clinical StudiesEffects of multidisciplinary case management in patients with chronic renal insufficiency∗☆,
Section snippets
Study site and subjects
This study was approved by the Indiana University Institutional Review Board. Patients were recruited from the general medicine practice of the Regenstrief Health Center, a multispecialty outpatient facility affiliated with, and located adjacent to, Wishard Memorial Hospital, an urban public teaching hospital. The general medicine practice has been the site of many randomized trials of health services interventions in primary care 32, 33, 34, 35. At the time of this study, it was divided into
Results
Enrollment began in June 1989 and continued for 2 years. During this time, 597 eligible patients kept general medicine practice appointments. Of these, 437 (73%) agreed to participate in the study and completed in-home interviews. Of the 160 patients not enrolled, 154 (96%) refused participation; for the remaining six (4%) the patient’s physician deemed the study inappropriate for the patient. Of the 437 enrolled patients, 206 (47%) received primary care in the two general medicine practice
Discussion
This intensive and expensive multidisciplinary case-management intervention had no important effects on renal dysfunction, health-care utilization, or mortality among a cohort of urban patients with established chronic renal insufficiency. Moreover, there were few demonstrable effects of the intervention on the management of intervention patients despite frequent and direct communications between the study nephrologists and the patients’ primary care physicians. However, a substantial
Acknowledgements
We gratefully thank Jane Rust, RN, nursing unit manager of the general medicine practice, for her unflagging support of our research efforts; Mary Robbins-Nierste for her support in establishing the nephrology case management clinic, and especially the physicians, nurses, nurses’ aids, and Regenstrief clinic clerks for their continued support of this and other research efforts. In addition, we wish to acknowledge Karen Graves, Connie Summitt, Paula Dahr, and Beatrice Schalter who formed the
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Supported in part by grants from The Indianapolis Health Foundation (FCL), The Indianapolis Foundation (LEH, WMT), The Picker-Commonwealth Program for Patient-Centered Care (LEH), and The Agency for Health Care Policy and Research (HS04996, HS05626, HS07632, HS07719, HS07763, and HS09083) (WMT).
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