ArticlePloS one2025
Association of healthcare fragmentation with three-year survival among kidney transplant recipients in Colombia.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Difficulties with clinical practice guidelines for congenital syphilis prevention in Colombia: a qualitative study.BMC infectious diseases · 2026Article
- Experience and outcomes of kidney transplantation in a Colombian referral center.Frontiers in nephrology · 2026Article
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Authors and funding
3 authors.
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Abstract
objectiveKidney transplantation requires a multidisciplinary approach to achieve optimal outcomes. Healthcare fragmentation, defined by inadequate communication and lack of integration among providers, disrupts the continuum of care, leading to adverse clinical outcomes. Latin American countries face significant challenges in delivering integrated healthcare. This fragmentation is further exacerbated in Colombia by the decentralized structure of the healthcare system, which disperses responsibilities across multiple actors, including public and private providers, insurers, and regional authorities. This study aimed to assess healthcare fragmentation in kidney transplant patients during their first post-transplant year and evaluate its association with three-year survival among patients enrolled in Colombia's contributory healthcare scheme.
methodsA retrospective cohort study was conducted using administrative data from Colombia's contributory healthcare scheme. The cohort included kidney transplant recipients (2012-2016) who survived the first post-transplant year. Healthcare fragmentation was measured by the number of unique providers involved in the first year. Patients were categorised into high- and low-fragmentation groups based on the 75th percentile of provider distribution. The primary outcome was three-year survival, analysed using multivariate Cox regression to estimate hazard ratios (HRs), adjusted for age, sex, Charlson Comorbidity Index (CCI), insurer, region, and transplant year.
resultsThe cohort comprised 2,028 kidney transplant patients, with a mean age of 47.7 years (SD: 13.4), 38.7% female, and 68.7% presenting a CCI ≤ 3. Healthcare fragmentation ranged from 1 to 34 providers, with a mean of 8.94 (SD: 6.77). High fragmentation (≥11 providers) was observed in 30.2% of patients. Three-year mortality was significantly higher in the high-fragmentation group (18%) compared to the low-fragmentation group (12%) (p = 0.04). High fragmentation was associated with a 49% increased mortality risk (adjusted HR: 1.49; 95% CI: 1.12-1.97; p = 0.01).
conclusionThese findings underscore the importance of integrated care models and improved coordination among providers to enhance patient outcomes, particularly in resource-limited settings.
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