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. 2017 Nov 3;3(2):343-355.
doi: 10.1016/j.ekir.2017.10.014. eCollection 2018 Mar.

Potentially Avoidable Readmissions in United States Hemodialysis Patients

Anna T Mathew  1 , Lisa Rosen  2 , Renee Pekmezaris  3 , Andrzej Kozikowski  3 , Daniel W Ross  3 , Thomas McGinn  3 , Kamyar Kalantar-Zadeh  4   5   6 , Steven Fishbane  3
Affiliations

Potentially Avoidable Readmissions in United States Hemodialysis Patients

Anna T Mathew et al. Kidney Int Rep. .

Abstract

Introduction: Patients with end-stage kidney disease have a high risk of 30-day readmission to hospital. These readmissions are financially costly to health care systems and are associated with poor health-related quality of life. The objective of this study was to describe and analyze the frequency, causes, and predictors of 30-day potentially avoidable readmission to hospital in patients on hemodialysis.

Methods: We conducted a retrospective cohort study using the US Renal Data System data from January 1, 2008, to December 31, 2008. A total of 107,940 prevalent United States hemodialysis patients with 248,680 index hospital discharges were assessed for the main outcome of 30-day potentially avoidable readmission, as identified by a computerized algorithm.

Results: Of 83,209 30-day readmissions, 59,045 (70.1%) resulted in a 30-day potentially avoidable readmission. The geographic distribution of 30-day potentially avoidable readmission in the United States varied by state. Characteristics associated with 30-day potentially avoidable readmission included the following: younger age, shorter time on hemodialysis, at least 3 or more hospitalizations in preceding 12 months, black race, unemployed status, treatment at a for-profit facility, longer length of index hospital stay, and index hospitalizations that involved a surgical procedure. The 5-, 15-, and 30-day potentially avoidable readmission cumulative incidences were 6.0%, 15.1%, and 25.8%, respectively.

Conclusion: Patients with end-stage kidney disease on maintenance hemodialysis are at high risk for 30-day readmission to hospital, with nearly three-quarters (70.1%) of all 30-day readmissions being potentially avoidable. Research is warranted to develop cost-effective and transferrable interventions that improve care transitions from hospital to outpatient hemodialysis facility and reduce readmission risk for this vulnerable population.

Keywords: ESKD; avoidable; epidemiology; hemodialysis; hospitalization; readmission.

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Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Index hospital discharge outcomes and frequencies.
Figure 3
Figure 3
Geographic variation in 30-day potentially avoidable readmission. ∗Percentages of 30-day potentially avoidable readmission presented as proportion of index hospitalization.
Figure 4
Figure 4
Hazard function for potentially avoidable readmission.
See this image and copyright information in PMC

References

    1. Osman I.M., Godden D.J., Friend J.A. Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax. 1997;52:67–71. - PMC - PubMed
    1. Raymond T.A.S., Lander S., Gorodeski E. Patient-reported health related quality of life (EQ-5D) predicts readmission risk. J Am Coll Cardiol. 2012;59 E1890–E1890.
    1. Robert Wood Johnson Foundation. The revolving door: a report on US hospital readmissions. 2013. Available at: http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf404178. Accessed February 19, 2015.
    1. Phillips C.O., Wright S.M., Kern D.E. Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure:a meta-analysis. JAMA. 2004;291:1358–1367. - PubMed
    1. USRDS 2014 Hospitalizations. 2015. Available at: http://www.usrds.org/2014/view/v2_04.aspx. Accessed June 12, 2015.