Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study

Chi-Sheng Hung, Jenkuang Lee, Ying-Hsien Chen, Ching-Chang Huang, Vin-Cent Wu, Hui-Wen Wu, Pao-Yu Chuang, Yi-Lwun Ho, Chi-Sheng Hung, Jenkuang Lee, Ying-Hsien Chen, Ching-Chang Huang, Vin-Cent Wu, Hui-Wen Wu, Pao-Yu Chuang, Yi-Lwun Ho

Abstract

Background: Chronic kidney disease (CKD) is prevalent in Taiwan and it is associated with high all-cause mortality. We have shown in a previous paper that a fourth-generation telehealth program is associated with lower all-cause mortality compared to usual care with a hazard ratio of 0.866 (95% CI 0.837-0.896).

Objective: This study aimed to evaluate the effect of renal function status on hospitalization among patients receiving this program and to evaluate the relationship between contract compliance rate to the program and risk of hospitalization in patients with CKD.

Methods: We retrospectively analyzed 715 patients receiving the telehealth care program. Contract compliance rate was defined as the percentage of days covered by the telehealth service before hospitalization. Patients were stratified into three groups according to renal function status: (1) normal renal function, (2) CKD, or (3) end-stage renal disease (ESRD) and on maintenance dialysis. The outcome measurements were first cardiovascular and all-cause hospitalizations. The association between contract compliance rate, renal function status, and hospitalization risk was analyzed with a Cox proportional hazards model with time-dependent covariates.

Results: The median follow-up duration was 694 days (IQR 338-1163). Contract compliance rate had a triphasic relationship with cardiovascular and all-cause hospitalizations. Patients with low or very high contract compliance rates were associated with a higher risk of hospitalization. Patients with CKD or ESRD were also associated with a higher risk of hospitalization. Moreover, we observed a significant interaction between the effects of renal function status and contract compliance rate on the risk of hospitalization: patients with ESRD, who were on dialysis, had an increased risk of hospitalization at a lower contract compliance rate, compared with patients with normal renal function or CKD.

Conclusions: Our study showed that there was a triphasic relationship between contract compliance rate to the telehealth program and risk of hospitalization. Renal function status was associated with risk of hospitalization among these patients, and there was a significant interaction with contract compliance rate.

Keywords: chronic kidney disease; contract compliance rate; telehealth.

Conflict of interest statement

Conflicts of Interest: None declared.

©Chi-Sheng Hung, Jenkuang Lee, Ying-Hsien Chen, Ching-Chang Huang, Vin-Cent Wu, Hui-Wen Wu, Pao-Yu Chuang, Yi-Lwun Ho. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.01.2018.

Figures

Figure 1
Figure 1
Incubation periods of the intervention’s effect at event times. The A, B, and C represent three fictitious participants. The green color indicates that the participant is using the telehealth service, the gray color indicates that the participant is not using telehealth service, and the blue color indicates that the participant is in the incubation period (defined as 28 days before a specific event). The T1, T2, and T3 are times when a participant develops an event (participants A, C, and B, respectively).
Figure 2
Figure 2
Kaplan-Meier curve for time to the first cardiovascular (CV) hospitalization.
Figure 3
Figure 3
Kaplan-Meier curve for time to the first all-cause hospitalization.
Figure 4
Figure 4
Generalized additive model (GAM) plot to assess the nonlinear relationship between contract compliance rate within 24 weeks and risk of cardiovascular hospitalization. Note: logit(P) was the logit transformation of probability(P)=ln(P/[1–P]).
Figure 5
Figure 5
Generalized additive model (GAM) plot to assess the nonlinear relationship between contract compliance rate within 24 weeks and risk of cardiovascular hospitalization for participants with normal renal function. Note: logit(P) was the logit transformation of probability(P)=ln(P/[1–P]).
Figure 6
Figure 6
Generalized additive model (GAM) plot to assess the nonlinear relationship between contract compliance rate within 24 weeks and risk of cardiovascular hospitalization for participants with chronic kidney disease. Note: logit(P) was the logit transformation of probability(P)=ln(P/[1–P]).
Figure 7
Figure 7
Generalized additive model (GAM) plot to assess the nonlinear relationship between contract compliance rate within 24 weeks and risk of cardiovascular hospitalization for participants with end-stage renal disease. Note: logit(P) was the logit transformation of probability(P)=ln(P/[1–P]).

References

    1. McLean S, Chandler D, Nurmatov U, Liu J, Pagliari C, Car J, Sheikh A. Telehealthcare for asthma. Cochrane Database Syst Rev. 2010 Oct 06;(10):CD007717. doi: 10.1002/14651858.CD007717.pub2.
    1. McLean S, Nurmatov U, Liu JL, Pagliari C, Car J, Sheikh A. Telehealthcare for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;(7):CD007718. doi: 10.1002/14651858.CD007718.pub2.
    1. Clark RA, Inglis SC, McAlister FA, Cleland JG, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ. 2007 May 5;334(7600):942. doi: 10.1136/bmj.39156.536968.55.
    1. Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, Stewart S, Cleland JG. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2010;(8):CD007228. doi: 10.1002/14651858.CD007228.pub2.
    1. Hung C, Yu J, Lin Y, Chen Y, Huang C, Lee J, Chuang P, Ho Y, Chen M. Mortality benefit of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease: a longitudinal study. J Med Internet Res. 2016 May 13;18(5):e102. doi: 10.2196/jmir.5718.
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Dec 23;351(13):1296–1305. doi: 10.1056/NEJMoa041031.
    1. Wheeler DC, Becker GJ. Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease? Kidney Int. 2013 Mar;83(3):377–383. doi: 10.1038/ki.2012.425.
    1. Burnier M, Pruijm M, Wuerzner G, Santschi V. Drug adherence in chronic kidney diseases and dialysis. Nephrol Dial Transplant. 2015 Jan;30(1):39–44. doi: 10.1093/ndt/gfu015.
    1. Remuzzi G, Benigni A, Finkelstein FO, Grunfeld J, Joly D, Katz I, Liu Z, Miyata T, Perico N, Rodriguez-Iturbe B, Antiga L, Schaefer F, Schieppati A, Schrier RW, Tonelli M. Kidney failure: aims for the next 10 years and barriers to success. Lancet. 2013 Jul 27;382(9889):353–362. doi: 10.1016/S0140-6736(13)60438-9.
    1. Gallar P, Vigil A, Rodriguez I, Ortega O, Gutierrez M, Hurtado J, Oliet A, Ortiz M, Mon C, Herrero JC, Lentisco C. Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis. J Telemed Telecare. 2007 Jun;13(6):288–292. doi: 10.1258/135763307781644906.
    1. Nakamoto H. Telemedicine system for patients on continuous ambulatory peritoneal dialysis. Perit Dial Int. 2007 Jun;27 Suppl 2:S21–S26.
    1. Kessler M, Erpelding M, Empereur F, Rose C. Transplantélic : une application de télémédecine en transplantation rénale. Eur Res Telemed. 2013 Mar;2(1):5–10. doi: 10.1016/j.eurtel.2013.01.002.
    1. Wen CP, Cheng TY, Tsai MK, Chang YC, Chan HT, Tsai SP, Chiang PH, Hsu CC, Sung PK, Hsu YH, Wen SF. All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet. 2008 Jun 28;371(9631):2173–2182. doi: 10.1016/S0140-6736(08)60952-6.
    1. National Kidney Foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1–S266.
    1. Ho Y, Yu J, Lin Y, Chen Y, Huang C, Hsu T, Chuang P, Hung C, Chen M. Assessment of the cost-effectiveness and clinical outcomes of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease. J Med Internet Res. 2014;16(6):e145. doi: 10.2196/jmir.3346.
    1. Yao X, Abraham NS, Alexander GC, Crown W, Montori VM, Sangaralingham LR, Gersh BJ, Shah ND, Noseworthy PA. Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. J Am Heart Assoc. 2016 Feb 23;5(2):e003074. doi: 10.1161/JAHA.115.003074.
    1. Chen Y, Sloan FA, Yashkin AP. Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death. J Diabetes Complications. 2015;29(8):1228–1233. doi: 10.1016/j.jdiacomp.2015.07.005.
    1. Marzluf BA, Reichardt B, Neuhofer LM, Kogler B, Wolzt M. Influence of drug adherence and medical care on heart failure outcome in the primary care setting in Austria. Pharmacoepidemiol Drug Saf. 2015 Jul;24(7):722–730. doi: 10.1002/pds.3790.
    1. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011 Apr;86(4):304–314. doi: 10.4065/mcp.2010.0575.
    1. Hameed AS, Sauermann S, Schreier G. The impact of adherence on costs and effectiveness of telemedical patient management in heart failure: a systematic review. Appl Clin Inform. 2014;5(3):612–620. doi: 10.4338/ACI-2014-04-RA-0037.
    1. Chaudhry SI, Mattera JA, Curtis JP, Spertus JA, Herrin J, Lin Z, Phillips CO, Hodshon BV, Cooper LS, Krumholz HM. Telemonitoring in patients with heart failure. N Engl J Med. 2010 Dec 9;363(24):2301–2309. doi: 10.1056/NEJMoa1010029.
    1. Takahashi PY, Pecina JL, Upatising B, Chaudhry R, Shah ND, Van HH, Cha S, Croghan I, Naessens JM, Hanson GJ. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Arch Intern Med. 2012 May 28;172(10):773–779. doi: 10.1001/archinternmed.2012.256.
    1. Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, Lee DS. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail. 2012 Jul 01;5(4):414–421. doi: 10.1161/CIRCHEARTFAILURE.111.964791.
    1. Desai AS. The three-phase terrain of heart failure readmissions. Circ Heart Fail. 2012 Jul 01;5(4):398–400. doi: 10.1161/CIRCHEARTFAILURE.112.968735.
    1. Desai AS, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation. 2012 Jul 24;126(4):501–506. doi: 10.1161/CIRCULATIONAHA.112.125435.
    1. Ishani A, Christopher J, Palmer D, Otterness S, Clothier B, Nugent S, Nelson D, Rosenberg ME, Center for Innovative Kidney Care Telehealth by an interprofessional team in patients with CKD: a randomized controlled trial. Am J Kidney Dis. 2016 Jul;68(1):41–49. doi: 10.1053/j.ajkd.2016.01.018.
    1. Thilly N, Chanliau J, Frimat L, Combe C, Merville P, Chauveau P, Bataille P, Azar R, Laplaud D, Noël C, Kessler M. Cost-effectiveness of home telemonitoring in chronic kidney disease patients at different stages by a pragmatic randomized controlled trial (eNephro): rationale and study design. BMC Nephrol. 2017 Apr 05;18(1):126. doi: 10.1186/s12882-017-0529-2.
    1. Warren R, Carlisle K, Mihala G, Scuffham PA. Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: a randomised controlled trial. J Telemed Telecare. 2017 Jan 01;:1357633X17723943. doi: 10.1177/1357633X17723943.
    1. Bashi N, Karunanithi M, Fatehi F, Ding H, Walters D. Remote monitoring of patients with heart failure: an overview of systematic reviews. J Med Internet Res. 2017 Jan 20;19(1):e18. doi: 10.2196/jmir.6571.
    1. Lundell S, Holmner A, Rehn B, Nyberg A, Wadell K. Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea. Respir Med. 2015 Jan;109(1):11–26. doi: 10.1016/j.rmed.2014.10.008.
    1. Faruque LI, Wiebe N, Ehteshami-Afshar A, Liu Y, Dianati-Maleki N, Hemmelgarn BR, Manns BJ, Tonelli M, Alberta Kidney Disease Network Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ. 2017 Mar 06;189(9):E341–E364. doi: 10.1503/cmaj.150885.
    1. Richard CJ. Self-care management in adults undergoing hemodialysis. Nephrol Nurs J. 2006;33(4):387–394; quiz 395.
    1. Mawar S, Gupta S, Mahajan S. Non-compliance to the continuous ambulatory peritoneal dialysis procedure increases the risk of peritonitis. Int Urol Nephrol. 2012 Aug;44(4):1243–1249. doi: 10.1007/s11255-011-0079-7.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa