{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T14:27:01Z","timestamp":1791124021070,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>A multidisciplinary team (MDT) approach to chronic kidney disease (CKD) may help optimize care of CKD and comorbidities. We implemented an MDT quality improvement project for persons with stage 3 CKD and comorbid diabetes and\/or hypertension. Our objective was to decrease the rate of decline of GFR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>\n                      We used a 4-year historical cohort to compare 1769 persons referred for usual nephrology care\n                      <jats:italic toggle=\"yes\">versus 233<\/jats:italic>\n                      referred for MDT care within an integrated, not-for-profit Health Maintenance Organization (HMO). Usual care consisted of referral to an outside nephrologist. The MDT consisted of an HMO-based nephrologist, pharmacy specialist, diabetes educator, dietitian, social worker, and nephrology nurse. Both groups received usual primary care. The primary outcome was rate of decline of GFR. Secondary outcomes were LDL, hemoglobin A1c, and BP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In multivariate repeated-measures analyses, MDT care was associated with a mean annual decline in GFR of 1.2\n                      <jats:italic toggle=\"yes\">versus<\/jats:italic>\n                      2.5 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      for usual care. In stratified analyses, the significant difference in GFR decline persisted only in those who completed their referrals. There were no differences in the secondary outcomes between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this integrated care setting, MDT care resulted in a slower decline in GFR than usual care. This occurred despite a lack of significant differences for secondary disease-specific measures, suggesting that other differences in the MDT population or care process accounted for the slower decline in GFR in the MDT group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.06610810","type":"journal-article","created":{"date-parts":[[2011,1,27]],"date-time":"2011-01-27T22:50:39Z","timestamp":1296168639000},"page":"704-710","source":"Crossref","is-referenced-by-count":151,"title":["Multidisciplinary Team Care May Slow the Rate of Decline in Renal Function"],"prefix":"10.2215","volume":"6","author":[{"given":"Elizabeth A.","family":"Bayliss","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharati","family":"Bhardwaja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Beck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane M.","family":"Lanese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-4-20230811","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1001\/jama.298.17.2038","article-title":"Prevalence of chronic kidney disease in the United States","volume":"298","author":"Coresh","year":"2007","journal-title":"JAMA"},{"key":"R3-4-20230811","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1053\/j.ajkd.2007.12.016","article-title":"CKD in the United States: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999\u20132004","volume":"51","author":"Whaley-Connell","year":"2008","journal-title":"Am J Kidney Dis"},{"key":"R4-4-20230811","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1053\/j.ajkd.2006.04.083","article-title":"Impact of comorbidities on mortality in managed care patients with CKD","volume":"48","author":"Gullion","year":"2006","journal-title":"Am J Kidney Dis"},{"key":"R5-4-20230811","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1681\/ASN.V1281713","article-title":"Opportunities for improving the care of patients with chronic renal insufficiency: Current practice patterns","volume":"12","author":"Nissenson","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"R6-4-20230811","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1681\/ASN.V1271501","article-title":"Management of patients with chronic renal insufficiency in the Northeastern United States","volume":"12","author":"Kausz","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"R7-4-20230811","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1046\/j.1445-5994.2002.00155.x","article-title":"Feasibility study of the early detection and treatment of renal disease by mass screening","volume":"32","author":"Craig","year":"2002","journal-title":"Intern Med J"},{"key":"R8-4-20230811","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1056\/NEJMoa041031","article-title":"Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization","volume":"351","author":"Go","year":"2004","journal-title":"N Engl J Med"},{"key":"R10-4-20230811","doi-asserted-by":"crossref","first-page":"9","DOI":"10.7326\/0003-4819-140-1-200401060-00006","article-title":"The prevalence of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease","volume":"140","author":"Muntner","year":"2004","journal-title":"Ann Intern Med"},{"key":"R11-4-20230811","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1681\/ASN.V133745","article-title":"Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States","volume":"13","author":"Muntner","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"R12-4-20230811","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/S0272-6386(98)70145-3","article-title":"Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease","volume":"32","author":"Levey","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"R13-4-20230811","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/ajkd.1998.v32.pm9820462","article-title":"On the epidemic of cardiovascular disease in patients with chronic renal disease and progressive renal failure: A first step to improve the outcomes","volume":"32","author":"Eknoyan","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"R14-4-20230811","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.mcna.2004.12.002","article-title":"Multiple risk factor intervention in chronic kidney disease: Management of cardiac disease in chronic kidney disease patients","volume":"89","author":"Curtis","year":"2005","journal-title":"Med Clin North Am"},{"key":"R15-4-20230811","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/S0140-6736(09)62004-3","article-title":"Early recognition and prevention of chronic kidney disease","volume":"375","author":"James","year":"2010","journal-title":"Lancet"},{"key":"R16-4-20230811","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/S0272-6386(03)00188-4","article-title":"Chronic kidney disease: issues and establishing programs and clinics for improved patient outcomes","volume":"41","author":"St Peter","year":"2003","journal-title":"Am J Kidney Dis"},{"key":"R17-4-20230811","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1053\/j.arrt.2003.10.010","article-title":"Translating research findings of chronic kidney disease management to clinical practice: Challenges and opportunities","volume":"11","author":"Stevens","year":"2004","journal-title":"Adv Ren Replace Ther"},{"key":"R18-4-20230811","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1136\/bmj.320.7234.569","article-title":"The role of patient care teams in chronic disease management","volume":"320","author":"Wagner","year":"2000","journal-title":"BMJ"},{"key":"R19-4-20230811","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1001\/jama.288.14.1775","article-title":"Improving primary care for patients with chronic illness","volume":"288","author":"Bodenheimer","year":"2002","journal-title":"JAMA"},{"key":"R20-4-20230811","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1001\/jama.288.15.1909","article-title":"Improving primary care for patients with chronic illness: The chronic care model, Part 2","volume":"288","author":"Bodenheimer","year":"2002","journal-title":"JAMA"},{"key":"R21-4-20230811","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1053\/snep.2002.35970","article-title":"The role of comprehensive renal clinic in chronic kidney disease stabilization and management: The Northwestern experience","volume":"22","author":"Ghossein","year":"2002","journal-title":"Semin Nephrol"},{"key":"R22-4-20230811","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/S0002-9343(98)00329-5","article-title":"Effects of multidisciplinary case management in patients with chronic renal insufficiency","volume":"105","author":"Harris","year":"1998","journal-title":"Am J Med"},{"key":"R23-4-20230811","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1681\/ASN.2006080860","article-title":"Association between multidisciplinary care and survival for elderly patients with chronic kidney disease","volume":"18","author":"Hemmelgarn","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"R24-4-20230811","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/ndt\/gfh585","article-title":"The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes","volume":"20","author":"Curtis","year":"2005","journal-title":"Nephrol Dial Transplant"},{"key":"R25-4-20230811","first-page":"546","article-title":"Evaluating the consequences of multidisciplinary case management for patients with chronic renal failure","volume":"105","author":"Wrone","year":"1998","journal-title":"Am J Med"},{"key":"R26-4-20230811","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1001\/archinte.164.6.659","article-title":"Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization","volume":"164","author":"Keith","year":"2004","journal-title":"Arch Intern Med"},{"key":"R27-4-20230811","doi-asserted-by":"crossref","first-page":"461","DOI":"10.7326\/0003-4819-130-6-199903160-00002","article-title":"A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group","volume":"130","author":"Levey","year":"1999","journal-title":"Ann Intern Med"},{"key":"R28-4-20230811","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-Cm and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"key":"R29-4-20230811","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1093\/ndt\/gfp534","article-title":"Incident chronic kidney disease and the rate of kidney function decline in individuals with hypertension","volume":"25","author":"Hanratty","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"R30-4-20230811","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1001\/jama.2010.619","article-title":"Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death","volume":"303","author":"Hedayati","year":"2010","journal-title":"JAMA"},{"key":"R31-4-20230811","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1053\/j.ajkd.2009.03.017","article-title":"Prevalence of major depressive episode in CKD","volume":"54","author":"Hedayati","year":"2009","journal-title":"Am J Kidney Dis"},{"key":"R32-4-20230811","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/j.1755-6686.2008.00032.x","article-title":"Development of a self-management package for people with diabetes at risk of chronic kidney disease (CKD)","volume":"34","author":"Thomas","year":"2008","journal-title":"J Ren Care"},{"key":"R33-4-20230811","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1370\/afm.4","article-title":"Descriptions of barriers to self-care by persons with comorbid chronic diseases","volume":"1","author":"Bayliss","year":"2003","journal-title":"Ann Family Med"},{"key":"R34-4-20230811","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/j.1369-7625.2004.00312.x","article-title":"Collaborative care needs and preferences of primary care patients with multimorbidity","volume":"8","author":"Noel","year":"2005","journal-title":"Health Expectations"},{"key":"R35-4-20230811","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1007\/s11606-007-0313-2","article-title":"Beyond comorbidity counts: How do comorbidity type and severity influence diabetes patients' treatment priorities and self-management?","volume":"22","author":"Kerr","year":"2007","journal-title":"J Gen Intern Med"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201104000-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:40:35Z","timestamp":1786369235000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201104000-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,4]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2011]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.06610810","relation":{},"ISSN":["1555-9041"],"issn-type":[{"value":"1555-9041","type":"print"}],"subject":[],"published":{"date-parts":[[2011,4]]}}}