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Kidney Week

Abstract: FR-PO1157

Preventable 30-Day Readmission After Kidney Transplantation: Classification System and Risk Association

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Al Ammary, Fawaz, Johns Hopkins University, Baltimore, Maryland, United States
  • Crews, Deidra C., Johns Hopkins University, Baltimore, Maryland, United States
  • Brennan, Daniel C., Johns Hopkins, Baltimore, Maryland, United States
  • Wiseman, Alexander C., University of Colorado at Denver and Health Sciences Center, Denver, Colorado, United States
  • Massie, Allan, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Brotman, Daniel J., Johns Hopkins University, Baltimore, Maryland, United States

Group or Team Name

  • Johns Hopkins Epic Faculty Scholar Program
Background

Preventable readmissions post kidney transplantation (KT) may reflect cost inefficiencies and gaps in quality of care. There is no practical tool to identify preventable 30-day readmissions post KT, and it is not known whether socioeconomic status (SES) influences risk of preventable readmissions.

Methods

A single-center cohort of 756 adult first-time kidney-only transplant recipients from 2013-2017 was followed for 30 days post-discharge. We merged electronic health records with national databases to develop a classification system assignment of 30-day readmission (preventable vs. non-preventable) using All-Patient Refined Diagnosis Related Group and International Classification of Diseases, ninth and tenth revisions, Clinical Modification and assessed its performance and discrimination against clinical assignment (chart review). We used multivariable logistic regression to assess the independent association of patients’ SES and preventable readmissions.

Results

Recipient median age was 57 years (IQR, 45-66); 51% were white, 45% black, and 4% Hispanic. The sensitivity and specificity of the classification system were 92% and 96%, respectively, with area under the receiver-operating-characteristic curve (AUC) 0.94 (95%CI 0.89-0.97). Residents within the lowest ZIP code level neighborhood household income had the highest odds of preventable readmissions (adjusted odds ratio [OR] 2.16; 95%CI: 1.25-3.72).

Conclusion

Our classification system had a comparable discriminating ability to the gold standard of chart review identifying preventable vs. non-preventable 30-day readmission; however, our new tool requires prospective validation. Low income recipients had greater risk of preventable readmission.

Preventable ReadmissionClinically ObservedClinically Observed 
Classification SystemYesNoTotal
+67471
-699105
Total73103176

Sensitivity: 91.78%; Specificity: 96.12%. Area under ROC: 0.9395

Funding

  • Other NIH Support