Effectiveness of a Web-Based Provider Communications Platform in Reducing Hospital Readmissions Among Patients Receiving Dialysis: A Pilot Pre-Post Study

Abstract

Rationale & objective: Suboptimal care coordination between dialysis facilities and hospitals is an important driver of 30-day hospital readmissions among patients receiving dialysis. We examined whether the introduction of web-based communications platform ("DialysisConnect") was associated with reduced hospital readmissions.

Study design: Pilot pre-post study.

Setting & participants: A total of 4,994 index admissions at a single hospital (representing 2,419 patients receiving dialysis) during the study period (January 1, 2019-May 31, 2021).

Intervention: DialysisConnect was available to providers at the hospital and 4 affiliated dialysis facilities (=intervention facilities) during the pilot period (November 1, 2020-May 31, 2021).

Outcomes: The primary outcome was 30-day readmission; secondary outcomes included 30-day emergency department visits and observation stays. Interrupted time series and linear models with generalized estimating equations were used to assess pilot versus prepilot differences in outcomes; difference-in-difference analyses were performed to compare these differences between intervention versus control facilities. Sensitivity analyses included a third, prepilot/COVID-19 period (March 1, 2020-October 31, 2020).

Results: There was no statistically significant difference in the monthly trends in the 30-day readmissions pilot versus prepilot periods (-0.60 vs -0.13, P = 0.85) for intervention facility admissions; the difference-in-difference estimate was also not statistically significant (0.54 percentage points, P = 0.83). Similar analyses including the prepilot/COVID-19 period showed that, despite a substantial drop in admissions at the start of the pandemic, there were no statistically significant differences across the 3 periods. The age-, sex-, race-, and comorbid condition-adjusted, absolute pilot versus prepilot difference in readmissions rate was 1.8% (-3.7% to 7.3%); similar results were found for other outcomes.

Limitations: Potential loss to follow-up and pandemic effects.

Conclusions: In this pilot, the introduction of DialysisConnect was not associated with reduced hospital readmissions. Tailored care coordination solutions should be further explored in future, multisite studies to improve the communications gap between dialysis facilities and hospitals.

Keywords: Care coordination; dialysis; end-stage renal disease; hospital readmission; intervention; provider communication.

Graphical abstract

Figure 1

Interrupted time series of crude monthly readmission rates for index admissions at intervention facilities from January 1, 2019 to May 31, 2021, with introduction of the DialysisConnect pilot on November 1, 2021. Solid lines, fitted slopes for the prepilot and pilot periods; dashed lines, upper and lower bounds of the 95% confidence interval. Slopes were −0.13 (P = 0.60) and −0.60 (P = 0.81) for the prepilot and pilot periods, respectively; P = 0.76 for the change (β = 3.58) at the start of the pilot and P = 0.85 for the difference in slopes between the prepilot and pilot periods. CI, confidence interval.

Figure 2

Interrupted time series of crude monthly readmission rates for index admissions occurring January 1, 2019 to May 31, 2021, comparing intervention and control facilities, with introduction of the DialysisConnect pilot on November 1, 2021. Solid lines, fitted slopes for the prepilot and pilot periods; dashed lines, upper and lower bounds of the 95% confidence interval. For admissions among intervention versus control patients, slopes in the prepilot period were −0.13 (P = 0.59) versus −0.059 (P = 0.61); the difference in slopes in the prepilot period was −0.076 (P = 0.78). The “jump” at the start of the pilot was 5.88 (P = 0.09). Slopes were −0.60 (P = 0.81) and −1.07 (P = 0.12) for intervention versus control in the pilot period; the difference in slopes in the pilot period was 0.47 (P = 0.86). For other dialysis patients the pilot versus prepilot difference in slopes was −1.01 (P = 0.14); for intervention admissions, this difference was −0.47 (P = 0.85). The difference-in-difference estimate for intervention versus control, pilot versus prepilot was 0.54 (P = 0.83). CI, confidence interval.