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Abstract: FR-PO781

Recent Trends in Emergency and Observation Room Admissions Among Medicare Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

Among dialysis patients, emergency room (ER) and observation room (OBS) admissions - excluding those resulting in transfer to inpatient care - may reflect several factors, including morbidity and insufficient availability of outpatient clinic appointments. We assessed trends in ER/OBS admissions among Medicare dialysis patients in 2014-2016.

Methods

We analyzed Medicare limited data sets. For each calendar week (Monday to Sunday) in 2014-2016, we identified all Medicare Parts A and B beneficiaries with ≥1 outpatient dialysis treatment. We excluded patients hospitalized on Sunday and not discharged before the end of the day. During the next week, we calculated the percentage of patients with ≥1 ER/OBS admission not resulting in transfer to inpatient care. We fit an ARIMA(1,0,0)x(0,1,0) model to the time series of admission percentages and used a likelihood ratio test to assess whether a secular trend remained after accounting for serial correlation and seasonality. We analyzed the aggregate population and strata defined by age, race, sex, concurrent Medicaid enrollment, US Census Division, and dialytic modality (hemodialysis, peritoneal dialysis).

Results

The average number of Medicare dialysis patients per week was more than 286,000. As displayed in the figure, the mean percentage of dialysis patients with ≥1 ER/OBS admission each week was 2.97% in 2014, 3.04% in 2015, and 3.12% in 2016 (P < 0.001, from test of secular trend). The percentage of dialysis patients with ≥1 ER/OBS admission each week increased significantly (P < 0.05) in every stratum. Strata with the highest mean percentages of dialysis patients with ≥1 ER/OBS admission each week in 2016 were ages 20-34 years (5.14%), ages 35-44 years (4.04%), and Medicaid enrollees (3.83%).

Conclusion

Utilization of emergency and observation room care is increasing among Medicare dialysis patients.

Funding

  • Commercial Support