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Abstract: SA-PO343

A Retrospective Analysis of All-Cause Hospitalization and 30-Day Readmission in Clinics Participating in ESRD Seamless Care Organizations

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hippen, Benjamin E., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Lasky, Rachel A., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Ficociello, Linda, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Ketchersid, Terry L., Fresenius Medical Care, Waltham, Massachusetts, United States
Background

In 2015, the Center for Medicare and Medicaid Innovation (CMMI) implemented a pilot program known as ESRD Seamless Care Organizations (ESCOs) to reduce costs and maintain/improve care. This retrospective data analysis aims to evaluate hospitalizations in ESCO-eligible patients who received dialysis at ESCO vs non-ESCO clinics.

Methods

Adult, Fresenius Kidney Care (FKC) hemodialysis pts who met ESCO eligibility criteria between 10/2015-3/2017 were included. ESCO pts received dialysis at 1 of 6 FKC ESCO markets. The Non-ESCO pts were dialyzed at nearby FKC facilities that were propensity score matched on the following: number of ESCO eligible pts, mean dialysis vintage, mean pt age, %pts with diabetes, %pts with dual-eligibility, median income by zip code, and geographical proximity. Pts were further stratified by central venous catheter (CVC) use. Hospitalizations were identified using electronic medical records. Crude and adjusted Poisson regression models and chi-square testing were used.

Results

13,994 pts (7,398 ESCO and 6,596 non-ESCO) were included. Pts attending ESCO clinics had 0.97 times the rate of hospitalization when compared to non-ESCO clinics (p=0.013). In the multivariate model, ESCO clinic pts had 0.95 times the rate of hospitalization when compared to pts attending non-ESCO clinics (p=0.001). The difference between groups was narrowed when controlling for CVC; thus we stratified by CVC use (table). ESCO CVC pts had 0.90 the rate of hospitalization (p=0.0004) compared to non-ESCO CVC pts. There was no significant difference in the non-CVC subgroup. 30-day readmission rate did not differ between groups (p=0.59).

Conclusion

ESCO-eligible pts that received hemodialysis in FKC ESCO clinics experienced a lower rate of all-cause hospitalizations when compared to pts in non-ESCO clinics, a benefit primarily associated with pts that dialyzed using a CVC.

Funding

  • Commercial Support – Fresenius Medical Care