Discharge service as a determinant of 30-day readmission in a cohort of maintenance hemodialysis patients: a retrospective cohort study

Golestaneh, Ladan; Bellin, Eran; Southern, William N.; Melamed, Michal L.

doi:10.1186/s12882-017-0761-9

Cited by 3 publications

(6 citation statements)

References 39 publications

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“…Several publications examined the risk factors for readmissions and its prevalence among patients on dialysis (11)(12)(13)(14)(15)(16)(17)(18)(19). Prevalence of readmissions has varied from 12% to 90%, depending on the definition used as well as the clinical setting (20).…”

Section: Strategies To Reduce Recurrent Hospitalization In Patients W...mentioning

confidence: 99%

“…Hospital characteristics, such as location, level of acuity, and socioeconomic region, also affect risk of readmission. In a study of discharge service as a determinant of readmission risk, a hospitalist-led, nonteaching service was shown to have a 35% reduction in risk of readmission (18). Discharge to a skilled nursing facility (SNF) was associated with higher risk for readmission (18).…”

Section: Factors Associated With Readmissionmentioning

confidence: 99%

“…In a study of discharge service as a determinant of readmission risk, a hospitalist-led, nonteaching service was shown to have a 35% reduction in risk of readmission (18). Discharge to a skilled nursing facility (SNF) was associated with higher risk for readmission (18). Discharge on a weekend is associated with a higher risk for readmission (14).…”

Section: Factors Associated With Readmissionmentioning

confidence: 99%

“…The leading cause for index hospitalization was congestive heart failure (35%), followed by arrhythmias (11%) and acute coronary syndromes (9%). One in six patients was discharged to an SNF, and the mean length of stay was .4 days for the index hospitalization, both known risk factors for readmission (18,21). After an index hospitalization for cardiovascular cause, one in six patients is readmitted within 10 days, one in three is readmitted within 30 days, and 5% of deaths are noted within a 30-day period (29).…”

Section: Factors Associated With Readmissionmentioning

confidence: 99%

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Strategies to Reduce Rehospitalization in Patients with CKD and Kidney Failure

Doshi

Wish

2020

CJASN

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Readmissions in patients with nondialysis-dependent CKD and kidney failure are common and are associated with significant morbidity, mortality, and economic consequences. In 2013, the Centers for Medicare and Medicaid Services implemented the Hospital Readmissions Reduction Program in an attempt to reduce high hospitalization-associated costs. Up to 50% of all readmissions are deemed avoidable and present an opportunity for intervention. We describe factors that are specific to the patient, the index hospitalization, and underlying conditions that help identify the “high-risk” patient. Early follow-up care, developing volume management strategies, optimizing nutrition, obtaining palliative care consultations for seriously ill patients during hospitalization and conducting goals-of-care discussions with them, instituting systematic advance care planning during outpatient visits to avoid unwanted hospitalizations and intensive treatment at the end of life, and developing protocols for patients with incident or prevalent cardiovascular conditions may help prevent avoidable readmissions in patients with kidney disease.

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Section: Strategies To Reduce Recurrent Hospitalization In Patients W...mentioning

confidence: 99%

Section: Factors Associated With Readmissionmentioning

confidence: 99%

Section: Factors Associated With Readmissionmentioning

confidence: 99%

Section: Factors Associated With Readmissionmentioning

confidence: 99%

See 2 more Smart Citations

Strategies to Reduce Rehospitalization in Patients with CKD and Kidney Failure

Doshi

Wish

2020

CJASN

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“…Looking Glass™ Clinical Analytics (Streamline Health, Atlanta, Georgia) is a software application developed at Montefiore to help build a clinical database. It integrates clinical and administrative datasets to identify the specific patient cohorts and allows for retrospective measurement of our outcome [22, 23]. We included only adult patients (age > 21) who were receiving maintenance hemodialysis, with a mix of incident and prevalent hemodialysis patients.…”

Section: Methodsmentioning

confidence: 99%

The association of neighborhood racial mix and ED visit count in a cohort of patients on hemodialysis

et al. 2019

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Background Neighborhood racial mix is associated with dialysis facility performance metrics and mortality outcomes in patients on hemodialysis. We explored the association of neighborhood racial mix with emergency department (ED) visits in patients receiving hemodialysis. Methods Using Looking Glass (Montefiore’s clinical database) we identified a cohort of patients on hemodialysis with an index ED visit at any of 4 Montefiore Hospital locations, between January 2013 and December 2017 and followed it for number of ED visits through December of 2017 or dropout due to death. The racial mix data for the Bronx block group of each subject’s residence was derived from the Census Bureau. We then used negative binomial regression to test the association of quintile of percent of Black residents per residential block group with ED visits in unadjusted and adjusted models. To adjust further for quality offered by local dialysis facilities, with the facility zip code as the locus, we used data from the “Dialysis Compare” website. Results Three thousand nine-hundred and eighteen subjects were identified and the median number of ED visits was 3 (interquartile range (IQR) 1–7) during the study period. Subjects living in the highest quintile of percent Black residents were older, more commonly female and had lower poverty rates and higher rates of high school diplomas. Unadjusted models showed a significant association between the highest quintiles of Black neighborhood residence and count of ED visits. Fully adjusted, stratified models revealed that among males, and Hispanic and White subjects, living in neighborhoods with the highest quintiles of Black residents was associated with significantly more ED visits (p-trend =0.001, 0.02, 0.01 respectively). No association was found between dialysis facility locations’ quintile of Black residents and quality metrics. Conclusions Living in a neighborhood with a higher percentage of Black residents is associated with a higher number of ED visits in males and non-Black patients on hemodialysis. Electronic supplementary material The online version of this article (10.1186/s12882-019-1520-x) contains supplementary material, which is available to authorized users.

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Factors Associated With Hospital Readmissions Among U.S. Dialysis Facilities

Paulus¹,

Baernholdt²,

Kear³

et al. 2021

J Healthc Qual

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Introduction:The Centers for Medicare and Medicaid uses the standardized readmission ratio (SRR) to evaluate 30-day readmissions among dialysis providers in the U.S. Readmissions among dialysis recipients remains 37%. This study investigates associations among dialysis facilities and patient characteristics with facility's performance on the SRR.Methods:Descriptive, longitudinal, approach using multivariate regression analysis on data retrieved from the Dialysis Facility Report to evaluate the associations between facility-level (staffing, profit status, chain membership, clinic size, care, length of care, vascular access type, glomerular filtration rate (GFR), creatinine, hemoglobin, use of erythropoietin-stimulating agent, albumin, and primary dialysis modality) with the SRR.Results:Factors associated with a high SRR included nurse ratios, facility average GFR, and Northeast geographic location. Factors associated with a low SRR included patient care technician ratio, length of predialysis nephrology care, initiation of dialysis with an arteriovenous fistula, average hemoglobin, and Western geographic location.Conclusions:This study defines the influence predialysis nephrology care has on dialysis facilities SRRs. Access to care, adequate preparation for dialysis, and transitional support affect facilities' performance; however, without an appropriate staffing model, dialysis facilities may continue to struggle to reduce readmissions.

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Discharge service as a determinant of 30-day readmission in a cohort of maintenance hemodialysis patients: a retrospective cohort study

Cited by 3 publications

References 39 publications

Strategies to Reduce Rehospitalization in Patients with CKD and Kidney Failure

Strategies to Reduce Rehospitalization in Patients with CKD and Kidney Failure

The association of neighborhood racial mix and ED visit count in a cohort of patients on hemodialysis

Factors Associated With Hospital Readmissions Among U.S. Dialysis Facilities

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