The American journal of managed care · 2025
Value-based care interventions and management of CKD progression.
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Feeney Melissa, Mehltretter Joseph, Cheung Tammy, Simon Emily, Modarai Farhad
Аннотация
OBJECTIVES: This study aimed to evaluate the effectiveness of value-based care (VBC) interventions in slowing the progression of chronic kidney disease (CKD), as measured by changes in estimated glomerular filtration rate (eGFR) over time.
STUDY DESIGN: This retrospective cohort study used eGFR values from 2017 to 2023 to evaluate 623 patients with stage 3b or 4 CKD with routine eGFR testing who received VBC intervention. The focus was on comparing rates of eGFR decline before and after enrollment in the VBC.
METHODS: Linear regression was used to model patient-specific trajectories of kidney function across time using eGFR, with the slope serving as an estimate for the rate of disease progression.Patients were grouped into cohorts by disease stage, and mixed-effects models were used to compare the rates of eGFR decline pre- and post VBC intervention.
RESULTS: The rate of eGFR decline was slower across all CKD stages after enrollment compared with before, with a 77.2% reduction in the median rate of eGFR decline in stage 3b (P < .001) and 65.2% in stage 4 (P < .001). As a result of the reduced rates of disease progression, patients had higher median eGFR values at their latest month of eGFR measurement post enrollment compared with the eGFR values expected without a VBC intervention (stage 3b, 1.9 mL/min/1.73 m2 higher; stage 4, 3.5 mL/min/1.73 m2 higher).
CONCLUSIONS: Our findings indicate statistically significant differences in the rate of eGFR decline after enrollment in a VBC model, particularly for those in advanced CKD stages.
STUDY DESIGN: This retrospective cohort study used eGFR values from 2017 to 2023 to evaluate 623 patients with stage 3b or 4 CKD with routine eGFR testing who received VBC intervention. The focus was on comparing rates of eGFR decline before and after enrollment in the VBC.
METHODS: Linear regression was used to model patient-specific trajectories of kidney function across time using eGFR, with the slope serving as an estimate for the rate of disease progression.Patients were grouped into cohorts by disease stage, and mixed-effects models were used to compare the rates of eGFR decline pre- and post VBC intervention.
RESULTS: The rate of eGFR decline was slower across all CKD stages after enrollment compared with before, with a 77.2% reduction in the median rate of eGFR decline in stage 3b (P < .001) and 65.2% in stage 4 (P < .001). As a result of the reduced rates of disease progression, patients had higher median eGFR values at their latest month of eGFR measurement post enrollment compared with the eGFR values expected without a VBC intervention (stage 3b, 1.9 mL/min/1.73 m2 higher; stage 4, 3.5 mL/min/1.73 m2 higher).
CONCLUSIONS: Our findings indicate statistically significant differences in the rate of eGFR decline after enrollment in a VBC model, particularly for those in advanced CKD stages.