Abstract: SA-PO1102
Trends in Postacute Care for Older Adults Receiving Hemodialysis
Session Information
- Geriatric Nephrology
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Stedman, Margaret R., Stanford University, Stanford, California, United States
- Thomas, I-Chun, VA Palo Alto Health Care System, Palo Alto, California, United States
- Kurella Tamura, Manjula, Stanford University, Stanford, California, United States
- Liu, Christine, Stanford University, Stanford, California, United States
Background
To contain costs, Medicare has encouraged value-based models of care delivery. Medicare has supported multiple projects that have incentivized using less costly non-acute medical care, especially after a hospitalization. Yet whether such shifts in care delivery have impacted the care received by older adults receiving hemodialysis (HD), who have outsize health care costs, is unknown. We assessed the trends in the use of post-acute care services after a hospitalization, hypothesizing there would be greater use of skilled nursing facilities over time.
Methods
Using a retrospective cohort design with 2009 to 2021 United States Renal Data System data, we selected hospitalizations of persons who were ≥ 65 years and had been receiving outpatient HD ≥ 90 days. We excluded hospitalizations within 30 days of a prior hospitalization. For each hospitalization, we determined if persons were discharged to: a skilled nursing facility, home with home health services, home without services, or died.
Results
Our sample consisted of 906,101 hospitalizations of 187,701 persons. Mean length of stay was 6.4 days. Mean age was 78 years with 2.7 years of dialysis. We found the proportion of discharges to skilled nursing facilities varied between 26 to 30% over time. We found that the proportion of discharges to home with home health services steadily increased from 17% in 2009 to 25% in 2021. Correspondingly, the proportion of discharges to home without services has decreased over time from 45% to 37% (Figure). Using a multinomial regression approach, we will determine if specific Medicare projects are associated with these changes, adjusting for demographics and correlations between repeated visits.
Conclusion
Older persons receiving HD who have been hospitalized are increasingly going home with home health services. More analysis is needed to assess if greater use of home health services is associated with better clinical outcomes. Such data will provide crucial insights about the impact of value-based models of care delivery for older adults receiving hemodialysis.
Funding
- Other U.S. Government Support