location: nan, 'Thailand 
year: 2020 source: HSRI 
title: The synthesis of political suggestion for the development of health service system to delay Kidney failure : A case study at Chumphae Hospital 
abstract:The objectives of the mutual collaborations action research were to 1 ) develop the model of service activities in health services system for delaying progression of chronic kidney disease in all stages of kidney damage, 2) analyze the expense of resource investment in health services system for delaying progression of chronic kidney disease, and 3) synthesize the policy suggestions for health services system development to delay progression of chronic kidney disease in community hospitals. Purposive sampling was used and study subjects were 2 3 4 patients with chronic kidney disease (CKD) in all stages of kidney damage which were coursed by diabetes mellitus, hypertension, or both, at Chumpae Health Center or Primary Care Cluster (PCC), and Kidney Clinic at Chumpae Hospital, Khon Kaen Province. Secondary target group was healthcare team in both sites including 3 physicians, 4 professional nurses, and 1 pharmacist, and primary caregiver of CKD patients. There were 1 family doctor, 1 professional nurse at PCC; 2 medical doctors, 3 professional nurses at Kidney Clinic; 1 pharmacist running in both sites. Study Process: The study period was between April 2 5 6 2 and March 2 5 6 3 , however, was extended to July 2563. Study process was divided into 3 major steps; step 1 Implementation phase: a situation review of health services system for delaying dialysis according to the model developed from study in phase 1 ; step 2 implementation phase: planning, implementing, and evaluating the outcomes of health services system for delaying dialysis (Chumphae DDCKD model obtained from step 1); and step 3 evaluation phase: clinical outcomes were an average rapid eGFR decline < 4 ml/min/1 . 7 3 m2 / year in patients in all stages of kidney damage, selfmanagement behaviors, quality of life, and feasibility outcome of applying Chumphae DDCKD model in a real situation, including patient satisfaction, economic outcome: Cost-effectiveness analysis (CEA), and policy suggestions to health services system. Result: The effectiveness of applying DDCKD model for delaying progression of CKD or dialysis was tested at 3 rd and 6 th months and rapid eGFR decline was found to be decreased, rapid eGFR decline > 2 ml/min/1.73 m2/ in 6 months was only 29.06%, Patients having rapid eGFR decline < 4 ml/min/1.73 m2/year or < 2 ml/min/1.73 m2/in 6 months were 70.94%. rapid eGFR decline ≤ 2 ml/min/1.73 m2/in 6 months of CKD Patients in stage 1-2, 3a-3b, and 4-5 was found to be 74.68%, 64.71%, and 60.0%, respectively. The efficiency of Chumphae DDCK model for delaying dialysis in CKD patients with hypertension group showed that the median of rapid eGFR decline was significantly improved (p = 0.04). The study showed that score on self-management behaviors and eGFR in different periods were correlated. Prior to implementation of Chumphae DDCK model, total score on self-management behaviors changed 1 score, rapid eGFR decline would decrease to 2. 5 7 ml/min/1.73 m2. After implementation, rapid eGFR decline in 3rd and 6th months was 1.46 and 1 . 0 0 4 , respectively. An average total score on self-management behaviors before and after implementation 6 months was not significant difference. However, score on self-management behaviors in each item was significant difference, including eat bland food or less salty, eat dehydrated food or pickle food, eat high-cholesterol food, eat offal, water intake by estimating from urine output, and eat ready meal or food bought from convenience store. CKD patients in stage 1-2, 3a-3b, and 4-5 reported their quality of life score was mostly fine in every dimensions. The majority of subjects were satisfied with the new health services system in high level, followed by the highest level, and no report on less or the least levels. Cost-effectiveness analysis (CEA): after implementation of Chumphae DDCKD model, an average cost of CKD patients was 2,392.49 baht/person, 4,248.42 baht/person, and 4,181.42 baht/person in stage 1-2, 3a-3b, and 4-5, respectively. An average cost of CKD patients in stage 3 a-3 b and 4 - 5 was increased because of medical supplies, not insulin injection. Chumphae DDCKD model could delay > 5 0 % progression of chronic kidney disease in all stages of kidney damage. Cost-effectiveness analysis in this study was calculated based on numbers of CKD patients delaying progression of chronic kidney disease by considering from rapid eGFR decline < 4 ml/min/1.73 m2/year. Chumphae DDCKD model was more worth for CKD patients in stage 1-2 than for CKD patients in stage 3a-3b and stage 4-5, with the cost effectiveness of 3203.50 baht, 6,565.74 baht, and 6969.03 baht, respectively, on delaying progression of kidney damage for 1 person. The important policy suggestion was to implement Chumphae DDCK model for CKD patients because this model could delay progression of chronic kidney disease in all stages of kidney damage. However, it was worth for CKD patients in stage 1 - 2 when compared to other stages. Therefore, implementation of this model should establish in Kidney Clinic for CKD patients in early stage of kidney damage.