[Healthcare management protocols for chronic stone disease (Kaiser Permanente).].

Introduction: Stone disease is a chronic condition in a high percentage of patients. Duento the high healthcare costs associated with the treatment of this pathology, chronicity approaches and strategies should be adapted and used in a similar way to other chronic diseases. One of the models applied for the management of these diseases with a significant impact on the consumption of health resources is the Kaiser Permanente model.

Material And Methods: A chronic stone disease management project was developed and carried out in three different phases: Phase 1: identification of the target population of the program and design of the risk allocation model. The risk factors considered were CRG model (classification of risk groups or burden of morbidity) as a predictor of greater consumption of resources, anatomical risk factors, lithogenic risk factors, and hereditary factors associated with lithiasis. Phase 2: classification of patients according to risk and application of specific measures. The intervention measures will depend on the level of risk assigned: low, intermediate or high risk. Phase 3: analysis of indicators and results.

Results: An algorithm of risk allocation was designed, and a Kaiser pyramid drawn. A total of 59% of the patients were assigned to the low-risk group and 41% corresponded to high-risk (36.5%) or very high-risk patients (4.5%). Preliminary results obtained at two years of follow-up show a reduction in global stone recurrence by 42.2% when compared with a control group (classic follow-up). The overall adherence of the intervention group was 96.4% and the satisfaction of the patients included in the program was 9.93/10.

Conclusions: A management model for chronic stone disease based on the Kaiser Permanente pyramidis feasible. The implantation of this model has preliminarily demonstrated its efficiency in chronic patients.