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Abstract: FR-PO792

Prior Hospitalization Burden and the Relatedness of 30-Day Readmissions in Patients Receiving Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lin, Eugene, Stanford University, Palo Alto, California, United States
  • Bhattacharya, Jay, Stanford University, Palo Alto, California, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
Background

Thirty-day readmissions are common in patients receiving hemodialysis and costly to Medicare. Because patients on hemodialysis have a high background hospitalization rate, thirty-day readmissions might be less likely related to the index hospitalization or to the quality of post-discharge care than in patients with other conditions.

Methods

We evaluated whether prior hospitalization burden was associated with increased 30-day readmissions unrelated to the index hospitalization in adults with Medicare receiving hemodialysis in the United States from 1/1/2012-12/31/2013. We categorized a hospitalization, 30-day readmission pair as “related” if the principal diagnoses came from the same organ system. Using multinomial logistic regression, we estimated the likelihood that an index hospitalization was followed by a related or unrelated 30-day readmission.

Results

The adjusted probability of an unrelated 30-day readmission after any index hospitalization was 19.1% (95% CI: 18.9%, 19.3%) in patients with 0-1 hospitalizations in the prior year, 22.6% (95% CI: 22.4%, 22.8%) in patients with 2-4 hospitalizations, and 31.2% (95% CI: 30.8%, 31.5%) in patients with 5 or more hospitalizations. Cardiovascular index hospitalizations had the highest adjusted probability of a related 30-day readmission: 10.4% (95% CI: 10.2%, 10.7%), 13.6% (95% CI: 13.4%, 13.9%), and 20.8% (95% CI: 20.2%, 21.4%) respectively. Conversely, renal index hospitalizations had the lowest adjusted probability of a related 30-day readmission, 2.0% (95% CI: 1.8%, 2.3%), 3.9% (95% CI: 3.4%, 4.4%), and 5.1% (95% CI: 4.3%, 5.9%) respectively.

Conclusion

High prior hospitalization burden increases the likelihood that a patient receiving hemodialysis experiences a 30-day readmission unrelated to the index hospitalization. Healthcare payers such as Medicare should consider incorporating clinical relatedness into 30-day readmission quality measures.

Funding

  • NIDDK Support