Introduction:

The implementation of disease management models (DMM) has shown better health outcomes.

Objective:

To describe hospitalization and mortality rates in a cohort of patients on dialysis in which a DMM was implemented.

Materials and methods:

Prospective cohort study in which prevalent dialysis patients, older than 18 years of age, belonging to the health promoter of the contributory scheme (Nueva EPS), and with at least three months of intervention with DMM, were included in the Renal Therapy Services Network (RTS) between January 1 and December 31, 2014.To conduct the multivariate analysis, survival models and descriptive statistics were used.

Results:

2 525 patients were evaluated; median age was 64.5 years (IR=19); 56.9% (n=1 437) were on hemodialysis; 59.5% (n=1,503) were male, and a hospitalization rate of 1.15 events per patient/year was found (95% CI: 1.10-1.19) with 9.6 hospital patient days/year. The mortality rate was 146 deaths per 1 000 patients/year (95% CI: 130.3-163.6).

Conclusion:

Despite the high comorbidity observed in the population undergoing dialysis managed with DMM, favorable clinical outcomes were found.

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