Potentially Avoidable Readmissions in United States Hemodialysis Patients

Anna T. Mathew, Lisa Rosen, Renee Pekmezaris, Andrzej Kozikowski, Daniel W. Ross, Thomas McGinn, Kamyar Kalantar-Zadeh, Steven Fishbane

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

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.

Original languageEnglish
Pages (from-to)343-355
Number of pages13
JournalKidney International Reports
Volume3
Issue number2
DOIs
StatePublished - Mar 2018
Externally publishedYes

Keywords

  • ESKD
  • avoidable
  • epidemiology
  • hemodialysis
  • hospitalization
  • readmission

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