Post-hospitalization dialysis facility processes of care and hospital readmissions among hemodialysis patients: a retrospective cohort study

• Type of Material: Article
• Authors: Laura Christine Plantinga, Emory University; Tahsin Masud, Emory University; Janice Lea, Emory University; John M. Burkart, Wake Forest Baptist Medical Center; Christopher O'Donnell, Emory University; Bernard G. Jaar, Johns Hopkins University
• Language: English
• Date: 2018-07-31
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12882-018-0983-5
• Title of Journal or Parent Work: BMC Nephrology
• ISSN: 1471-2369
• Volume: 19
• Issue: 1
• Start Page: 186
• End Page: 186
• Grant/Funding Information: This project was supported by grant number R03HS025018 from the Agency for Healthcare Research and Quality.; The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality
• Keywords: OVERLOAD; Life Sciences & Biomedicine; ESRD; Science & Technology; Dialysis; OUTCOMES; Fluid overload; ASSOCIATION; DISCHARGE SUMMARIES; INFECTION-RELATED HOSPITALIZATION; Urology & Nephrology; Rehospitalization; Readmission; Pulmonary edema; QUALITY INCENTIVE PROGRAM
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background: Both dialysis facilities and hospitals are accountable for 30-day hospital readmissions among U.S. hemodialysis patients. We examined the association of post-hospitalization processes of care at hemodialysis facilities with pulmonary edema-related and other readmissions. Methods: In a retrospective cohort comprised of electronic medical record (EMR) data linked with national registry data, we identified unique patient index admissions (n = 1056; 2/1/10-7/31/15) that were followed by ≥3 in-center hemodialysis sessions within 10 days, among patients treated at 19 Southeastern dialysis facilities. Indicators of processes of care were defined as present vs. absent in the dialysis facility EMR. Readmissions were defined as admissions within 30 days of the index discharge; pulmonary edema-related vs. other readmissions defined by discharge codes for pulmonary edema, fluid overload, and/or congestive heart failure. Multinomial logistic regression to estimate odds ratios (ORs) for pulmonary edema-related and other vs. no readmissions. Results: Overall, 17.7% of patients were readmitted, and 8.0% had pulmonary edema-related readmissions (44.9% of all readmissions). Documentation of the index admission (OR = 2.03, 95% CI 1.07-3.85), congestive heart failure (OR = 1.87, 95% CI 1.07-3.27), and home medications stopped (OR = 1.81, 95% CI 1.08-3.05) or changed (OR = 1.69, 95% CI 1.06-2.70) in the EMR post-hospitalization were all associated with higher risk of pulmonary edema-related vs. no readmission; lower post-dialysis weight (by ≥0.5 kg) after vs. before hospitalization was associated with 40% lower risk (OR = 0.60, 95% CI 0.37-0.96). Conclusions: Our results suggest that some interventions performed at the dialysis facility in the post-hospitalization period may be associated with reduced readmission risk, while others may provide a potential existing means of identifying patients at higher risk for readmissions, to whom such interventions could be efficiently targeted.