gms | German Medical Science

Introduction: Chronic kidney disease (CKD) is characterized by gradual loss of kidney function over a period of months or years. Early detection can delay progression and the need for dialysis by optimal therapy of comorbidities, e.g., hypertension, hyperlipidemia, and diabetes mellitus [1]. Since 2009, the selective agreement (SeA) for insurees of AOK Sachsen-Anhalt provides a financial incentive for CKD screening of high-risk patients by general practitioners in Saxony-Anhalt (ST). After confirmed diagnosis by a nephrologist, the SeA provides a financial incentive for guideline-oriented treatment of CKD patients. Two main goals of the SeA are early detection and delay of CKD progression. In the literature, the effectiveness of targeted CKD screening programs is inconclusive [1], [2]. The objective of this study is to evaluate the SeA regarding health services quality and clinical outcomes.

Methods: Claims data of AOK Sachsen-Anhalt (intervention group) and AOK Nordost (region Mecklenburg-Vorpommern, MV, control group) including years between 2010 and 2017 will be compared. Only adult insurees with at least 365 days of follow-up, at least 90% follow-up spent in the federal state of their insurance, and insurance gaps less than 91 day will be included in further analyses. Insurees will be included as incident CKD patients if they had at least two CKD diagnoses (ICD-10 codes: N18, N19, I12.0, I13.1, E10.2, E11.2, E12.2, E13.2, E14.2) and excluded if they were insured for less than 365 days before the initial CKD diagnosis or had CKD diagnoses or outcome preceding the initial diagnosis. Temporal trends in health services usage, medication and number of CKD patients by stage will be analyzed using stratified descriptive statistics. In order to investigate the effect on outcomes, such as dialysis-free mortality, major adverse cardiovascular events, and hospitalization duration, Cox regression and Poisson regression will be used in longitudinal analyses. The analyses will control for demographic characteristics and comorbidities at the time point of the initial CKD diagnosis. In order to address immortal time bias regarding the start of SeA participation, time-dependent regression analysis will be used. Further components are analyses of medication changes after initial diagnosis of CKD as potential mechanism by which dialysis can be delayed, detailed analysis of medical records of randomly selected sample of SeA participants in the nephrologists` care and study of perceptions of medical professionals involved in the SeA. The analysis will be completed by a simulation model accounting for natural progression of the disease and will estimate long and short term effects of the SeA.

Results: To date, data cleaning is in progress. The content of the submission is description of the design of evaluation.

Discussion: This study will provide information about the effectiveness of the only screening program for CKD in Germany. In case of positive evaluation the SeA may be transferred to other regions of Germany.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.