Abstract: FR-PO896
Factors Associated with Higher Risk of Emergency Department Use within 30 days of Hospital Discharge
Session Information
- Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular
Authors
- Segal, Jonathan H., University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
- Stephen, John, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
- Shearon, Tempie H., University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
- Nan, Bin, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
- Hanna, Caitlin, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
- Dahlerus, Claudia, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
Background
Chronic dialysis patients visit the emergency department (ED) at 4-fould higher rates than Medicare beneficiaries in the general population yet little is known about outpatient ED use after hospital discharge. We examined clinical and sociodemographic/socioeconomic (SDS/SES) factors associated with increased ED use within 30 days after hospital discharge in the US Medicare dialysis population.
Methods
Data on ED visits (outpatient or observation stays) for dialysis patients in 2014 were obtained from Medicare Outpatient Claims. Adjustment was made for patient and area level clinical and SDS/SES characteristics. A two stage multivariate logistic regression model determined odds of an outpatient ED encounter within 30 days of an index hospital discharge adjusted for these SDS/SES and clinical factors.
Results
14.5 % of the 423,165 index discharges among 201,674 unique patients in 2014 were followed by an outpatient ED visits within 30 days. Females, younger age, longer ESRD vintage and black race were associated with higher odds of an ED encounter within 30 days. Dually-eligible (DE) patients (Medicare and Medicaid) had 13% higher odds compared to Medicare Primary; Medicare secondary patients/Medicare HMO had 54% lower odds of an ED encounter.
Conclusion
Outpatient ED encounters within 30 days after a hospital discharge occur frequently for chronic dialysis patients. Patient characteristics of SDS/SES (DE status, younger age, female sex) are associated with a higher risk of ED use following a hospital discharge. These ED visits represent an opportunity for greater coordination to reduce potentially preventable acute care.
| Covariate | Odds Ratio |
| Sex: Female | 1.09 |
| Age (Ref: 60-74) 18-24 | 2.16 |
| Age: 25-44 | 1.77 |
| Age 45-59 | 1.29 |
| Age 75+ | 0.86 |
| Obese (Ref: normal weight) | 0.94 |
| ESRD Vintage 5+ years (Ref: 1-2 y) | 1.08 |
| Black Race (Ref: White) | 1.15 |
| Medicare primary + Medicaid (Ref: Medicare primary) | 1.13 |
| Medicare secondary/HMO | 0.46 |
| Area Deprivation Index (ADI) | 1.06 |
all p-values <0.0001 except ADI where p=NS
Funding
- Other U.S. Government Support