Abstract: FR-PO895

Post-Hospitalization Dialysis Facility Processes of Care and Pulmonary Edema-Related Hospital Readmissions among Hemodialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Plantinga, Laura, Emory University, Atlanta, Georgia, United States
  • Lea, Janice P., Emory University, Atlanta, Georgia, United States
  • Masud, Tahsin, Emory University, Atlanta, Georgia, United States
  • Burkart, John M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Jaar, Bernard G., Johns Hopkins University and Nephrology Center of Maryland, Baltimore, Maryland, United States
Background

Both dialysis facilities and hospitals are accountable for 30-day readmissions among U.S. hemodialysis (HD) patients. Steps taken at the dialysis facility post-hospitalization may prevent pulmonary edema-related (PER) readmissions. We examined the association of post-hospitalization HD processes of care with PER readmissions.

Methods

Using electronic health record (EHR) data from 23 Southeastern dialysis facilities, starting in 2010 and linked with national registry data for complete follow-up through 2014, we identified 1454 in-center HD patients who had ≥1 hospitalization (first=index), survived ≥30 days, and had ≥3 contiguous dialysis sessions following the index discharge. Readmissions were defined as admissions that occurred within 30 days of the index discharge; PER readmissions were further defined by the presence of discharge codes for pulmonary edema, fluid overload, and/or congestive heart failure (CHF). Indicators of processes of care were defined by EHR data as present vs. absent in the first 3 sessions post-index discharge.

Results

Overall, 19.9% of patients were readmitted, and 8.3% had PER readmissions (38.7% of all readmissions). Compared to patients who did not, patients who had PER readmissions were slightly older (63.9 vs. 61.6 years; P=0.09), less likely to be black (54.6% vs. 63.4%; P=0.09) and more likely to have history of CHF (76.0% vs. 39.7%; P<0.001) or index admissions also related to pulmonary edema (72.7% vs. 35.1%; P<0.001). New dialysis orders, particularly with target weight changes, were more common among those with PER readmissions. Higher epoetin dose was less common in readmitted patients; drawing of labs was not different by readmission status (Table).

Conclusion

Patients who had PER readmissions were more, not less, likely to have target weight changes in dialysis orders and medication reductions within 3 sessions of index admission discharge. In general, these results suggest that usual post-hospitalization care at the dialysis facility may not prevent PER or all-cause readmissions.

Funding

  • Other U.S. Government Support