Abstract: FR-PO523
Assessing the Impact of Dialysis Modality on Hospitalization in a Large Population of ESRD Patients
Session Information
- Peritoneal Dialysis: Modality, Catheter, Infections
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Schreiber, Martin J., DaVita Inc, Denver, Colorado, United States
- Van hout, Bram, DaVita Inc, Denver, Colorado, United States
- Peterson, Zachariah W., DaVita Inc, Denver, Colorado, United States
- Cassin, Michelle, DaVita Inc, Denver, Colorado, United States
Background
Hospitalizations and readmissions pose a significant burden to ESRD patients and result in significant costs to the US health care system. There is increasing focus on patient outcomes and cost advantages for patients starting ESRD treatment on a home dialysis modality. Understanding the impact that specific modalities can have on hospitalizations may assist in changing physician behavior regarding initial modality selection.
Methods
Data were derived from adult patients receiving dialysis treatments in a large dialysis organization between 01 March 2016 and 31 March 2019. Hospitalization rates (overall and cause-specific), length of stay, and readmission rates were assessed separately for in-center hemodialysis (ICHD), peritoneal dialysis (PD), and home hemodialysis (HHD) patients. All outcomes were considered monthly and as 12-month rolling averages.
Results
As of March 2019, 12-month rolling average hospitalization rates were 1.24, 1.41, and 1.80 admits/year for PD, HHD, and ICHD patients, respectively; 30-day readmission rates were 26.2%, 24.3%, and 32.1% and mean length of stay was 6.62, 6.60, and 6.52 days, respectively. Significant variability was observed across geographic regions, with PD hospitalization rates ranging from 0.95 to 1.42 admissions/year and HHD hospitalization rates ranging from 1.13 to 1.66 admissions/year. Causes of hospitalization differed across modalities and programs: ICHD patients had higher rates of respiratory-related admissions and lower rates of admissions for gastrointestinal- and infection-related causes than patients on home modalities.
Conclusion
There is a pressing need to reduce hospitalization rates among ESRD patients to limit rising health care costs and improve outcomes. Here we demonstrate that hospitalization and readmission rates are consistently lower, and length of stay shorter, for patients using home dialysis modalities (PD and HHD) than those receiving ICHD. However, significant variability was observed across home programs, by program size and geographic location. Findings from this study have been used to develop a proactive approach to decreasing hospitalizations and readmissions based on program characteristics.
Funding
- Commercial Support –