Abstract: SA-PO969
Patterns of Emergency Department Visits Among American Dialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Gray, Kathryn S., DaVita Clinical Research, Minneapolis, Minnesota, United States
- Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States
- Tentori, Francesca, DaVita Clinical Research, Minneapolis, Minnesota, United States
- Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
Background
Dialysis patients are at risk for medical events requiring immediate intervention in the Emergency Department (ED). Despite this, patterns of ED visits among the contemporary dialysis population have not been described.
Methods
Data were derived from the 2016 Centers for Medicare and Medicaid Services 100% claims sample. Included patients were those who, in a given calendar month and for the preceding 3 months, were Medicare A & B eligible, diagnosed with ESRD, and treated with either in-center hemodialysis (ICHD) or peritoneal dialysis (PD). Core-based statistical areas were designated as urban; other regions were considered rural. Causes of ED visits and hospital admissions were ascribed based on the associated ICD-10 code and grouped using Clinical Classification Software categories. Outcomes were described as rates, counts, and percentages; no statistical comparisons were performed.
Results
Patients treated with ICHD (N=321,934) had 2.9 ED visits/patient-year; with 38.3% of visits resulting in hospital admission. PD patients (N=35,720) had 2.1 ED visits/patient-year, with 43.2% of visits resulting in admission. For both modalities, the majority of all hospital admissions initiated in the ED: 80.1% for ICHD and 74.8% for PD. ICHD patients residing in rural areas had a higher rate of ED visits compared to urban areas (3.1 vs 2.9/patient-year), although a smaller percentage of those ED visits resulted in hospital admission (30.5% vs 40.0%), corresponding to a lower overall hospitalization rate among rural patients (1.3 vs 1.4 admissions/patient-year). Similar trends were observed for PD. Across modalities, ED visits attributed to Diseases of the Circulatory System and Injury and Poisoning were common and likely to result in hospital admission; ED visits attributed to Infectious and Parasitic Diseases almost invariably resulted in admission.
Conclusion
ED visits are common among dialysis patients and precede the majority of hospitalizations. Understanding causes and patterns of ED visits may facilitate interventions to reduce the frequency of ED visits and subsequent admissions.