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Abstract: PO1064

Recent Trends in Acute Care Admissions Among Medicare Beneficiaries Undergoing Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Weinhandl, Eric D., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Kubisiak, Kristine, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Dalrymple, Lorien S., Fresenius Medical Care, Waltham, Massachusetts, United States
Background

While the rate of hospital admissions has been a bedrock measure of morbidity among dialysis patients, patients today may receive acute care during a hospital admission, observation status, or an emergency department (ED) visit. There are no public reports summarizing the composite rate of these encounters among dialysis patients. We used claims data to estimate rates of acute care admissions in dialysis patients with Medicare fee-for-service coverage.

Methods

Using Medicare Limited Data Sets, we identified all patients with Medicare Part B claims documenting outpatient dialysis from January 2014 to December 2017. For each calendar week (Monday to Sunday), we identified patients with at least one outpatient dialysis session, who were alive at the end of the week, and who were not hospitalized at the last midnight of the week. We calculated the proportion of patients who were admitted to the hospital, observation status (with discharge to home), or an ED (with discharge to home) during the subsequent calendar week. From the time series of weekly admission risks, we fit an autoregressive integrated moving average model, both overall and within strata defined by concurrent enrollment in Medicaid.

Results

From 2014 to 2017, mean weekly incidence of acute care admission increased from 5.8% in 2014 to 6.0% in 2017 (P < 0.01 from test of secular trend), as displayed. The incidence of hospital admission was unchanged (P = 0.35), whereas the incidence of both observation status admissions and ED visits increased (P < 0.01). In 2017, 49% of acute care admission volume was attributed to observation status admissions and ED visits. In patients with Medicare coverage alone and patients with concurrent enrollment in Medicaid, mean weekly incidence of acute care admission increased to 5.2% and 6.9%, respectively, in 2017.

Conclusion

From 2014 to 2017, the incidence of acute care admission increased in dialysis patients with Medicare fee-for-service coverage, mostly because of increasing incidence of observation status admissions and ED visits.

Funding

  • Commercial Support