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

Paulus, Amber B; Baernholdt, Marianne; Kear, Tamara; Jones, Terry; Thacker, Leroy R.

doi:10.1097/jhq.0000000000000300

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Although our intervention did not include a direct patient contact component, these prior results highlight the challenges for staff, particularly nurses, in dedicating time to such tasks, even when the tasks are supported by health care administration and assigned as part of the clinical workflow. This difficulty is exacerbated by inadequate dialysis nurse staffing levels, which have been shown to be predictive of hospital readmission [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study

Plantinga¹,

Hoge²,

Vandenberg³

et al. 2022

JMIR Form Res

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Background We piloted a web-based, provider-driven mobile app (DialysisConnect) to fill the communication and care coordination gap between hospitals and dialysis facilities. Objective This study aimed to describe the development and pilot implementation of DialysisConnect. Methods DialysisConnect was developed iteratively with focus group and user testing feedback and was made available to 120 potential users at 1 hospital (hospitalists, advanced practice providers [APPs], and care coordinators) and 4 affiliated dialysis facilities (nephrologists, APPs, nurses and nurse managers, social workers, and administrative personnel) before the start of the pilot (November 1, 2020, to May 31, 2021). Midpilot and end-of-pilot web-based surveys of potential users were also conducted. Descriptive statistics were used to describe system use patterns, ratings of multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators of and barriers to using DialysisConnect. Results The pilot version of DialysisConnect included clinical information that was automatically uploaded from dialysis facilities, forms for entering critical admission and discharge information, and a direct communication channel. Although physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activities were unevenly distributed; for example, 1 hospital-based APP recorded most of the admissions (280/309, 90.6%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users versus nonusers (eg, “I can see the potential value of DialysisConnect for my work with dialysis patients”: mean 2.8, SD 0.4, vs mean 2.3, SD 0.6; P=.02). Providers most commonly selected reduced time and energy spent gathering information as a motivator (11/26, 42%) and a lack of time to use the system as a barrier (8/26, 31%) at the end of the pilot. Conclusions This pilot study found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably while identifying substantial barriers to its use. These results inform how best to motivate providers to use this system and similar systems and inform future pragmatic research in care coordination among this and other populations.

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Section: Discussionmentioning

confidence: 99%

A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study

Plantinga¹,

Hoge²,

Vandenberg³

et al. 2022

JMIR Form Res

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“…In 2022, only approximately one-half of US dialysis PCTs intended to continue working as PCTs; of these, only 69% intended to continue working at the same facility . Frequent turnover could result in disengagement and burnout, inconsistent training, and, ultimately, reduced quality of delivered care and poor outcomes …”

Section: Introductionmentioning

confidence: 99%

“…4 Frequent turnover could result in disengagement and burnout, inconsistent training, and, ultimately, reduced quality of delivered care and poor outcomes. [5][6][7] Because of these concerns, a few states have instituted dialysis staffing mandates. 8 However, there is sparse, inconsistent evidence regarding the association of PCT staffing with in-center HD patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“… 4 Frequent turnover could result in disengagement and burnout, inconsistent training, and, ultimately, reduced quality of delivered care and poor outcomes. 5 , 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

“… 8 However, there is sparse, inconsistent evidence regarding the association of PCT staffing with in-center HD patient outcomes. 7 , 9 , 10 , 11 , 12 Here, we used national administrative data to examine the associations of patient-to-PCT ratios with incident patient mortality, transplantation, and hospitalization within 1 year of in-center HD start.…”

Section: Introductionmentioning

confidence: 99%

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Patient Care Technician Staffing and Outcomes Among US Patients Receiving In-Center Hemodialysis

Plantinga,

Bender,

Urbanski

et al. 2024

JAMA Netw Open

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ImportanceDialysis patient care technicians (PCTs) play a critical role in US in-center hemodialysis (HD) care, but little is known about the association of PCT staffing with patient outcomes at US HD facilities.ObjectiveTo estimate the associations of in-center HD patient outcomes with facility-level PCT staffing.Design, Setting, and ParticipantsThis was a retrospective cohort study, with data analysis performed from March 2023 to January 2024. Data on US patients with end-stage kidney disease and their treatment facilities were obtained from the US Renal Data System. Participants included patients (aged 18-100 years) initiating in-center HD between January 1, 2016, and December 31, 2018, who continued receiving in-center HD for 90 days or more and had data on PCT staffing at their initial treating HD facility.ExposureFacility-level patient-to-PCT ratios (number of HD patients divided by the number of PCTs reported by the treating facility in the prior year), categorized into quartiles (highest quartile denotes the highest PCT burden).Main Outcomes and MeasuresPatient-level outcomes included 1-year patient mortality, hospitalization, and transplantation. Associations of outcomes with quartile of patient-to-PCT ratio were estimated using incidence rate ratios (IRRs) from mixed-effects Poisson regression, with adjustment for patient demographics and clinical and facility factors.ResultsA total of 236 126 patients (mean [SD] age, 63.1 [14.4] years; 135 952 [57.6%] male; 65 945 [27.9%] Black; 37 777 [16.0%] Hispanic; 153 637 [65.1%] White; 16 544 [7.0%] other race; 146 107 [61.9%] with diabetes) were included. After full adjustment, the highest vs lowest quartile of facility-level patient-to-PCT ratio was associated with a 7% higher rate of patient mortality (IRR, 1.07; 95% CI, 1.02-1.12), a 5% higher rate of hospitalization (IRR, 1.05; 95% CI, 1.02-1.08), an 8% lower rate of waitlisting (IRR, 0.92; 95% CI, 0.85-0.98), and a 20% lower rate of transplant (IRR, 0.80; 95% CI, 0.71-0.91). The highest vs lowest quartile of patient-to-PCT ratio was also associated with an 8% higher rate of sepsis-related hospitalization (IRR, 1.08; 95% CI, 1.03-1.14) and a 15% higher rate of vascular access–related hospitalization (IRR, 1.15; 95% CI, 1.03-1.28).Conclusions and RelevanceThese findings suggest that initiation of treatment in facilities with the highest patient-to-PCT ratios may be associated with worse early mortality, hospitalization, and transplantation outcomes. These results support further investigation of the impact of US PCT staffing on patient safety and quality of US in-center HD care.

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Dialysis Facility Staffing Ratios and Kidney Transplant Access Among Adolescents and Young Adults

Bicki,

Grimes,

McCulloch

et al. 2024

JAMA

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ImportancePatient to staff ratios vary across US dialysis facilities and have been associated with patient outcomes in older adults.ObjectiveTo determine whether patient to nurse or patient to social worker staff ratios are associated with access to kidney transplant for adolescents and young adults.Design, Setting, and ParticipantsRetrospective cohort study including patients aged 12 to 30 years who started dialysis between 2005 and 2019 at 8490 US facilities according to the US Renal Data System, the national end-stage kidney disease registry.ExposuresTime-updated quartile of patient to nurse and patient to social worker ratios at dialysis facilities.Main Outcomes and MeasuresFine-Gray models were used to relate the exposure to the incidence of waitlisting and kidney transplant, accounting for the competing risk of death. Subgroup analysis by age at dialysis initiation (&lt;22 vs ≥22 years) was performed. Follow-up was censored in January 2020.ResultsA total of 54 141 participants were included (median age, 25 years [IQR, 21-28]; 54.4% male; 4.3% of Asian race, 35.3% of non-Hispanic Black race). The median patient to staff ratios were 14.4 patients per nurse (IQR, 10.3-18.9) and 91.0 patients per social worker (IQR, 65.2-115.0). During a median follow-up of 2.6 years, 39.9% of patients (n = 21 598) received a transplant. In adjusted analysis, the highest (vs lowest) quartile of patient to nurse ratios was associated with 14% lower incidence of transplant (subhazard ratio [SHR], 0.86 [95% CI, 0.82-0.91]). The highest (vs lowest) quartile of patient to social worker ratios was associated with lower incidence of waitlisting (SHR, 0.95 [95% CI, 0.91-0.99]) and transplant (SHR, 0.85 [95% CI, 0.81-0.89]). For both staff ratios, there was an interaction with age at dialysis initiation, such that the association was more pronounced in patients starting dialysis at younger than 22 years (SHR, 0.71 [95% CI, 0.65-0.78] for the highest vs lowest quartile for nursing; SHR, 0.74 [95% CI, 0.68-0.80] for social work) compared with those 22 years and older (SHR, 1.00 [95% CI, 0.94-1.06] for nursing; SHR, 0.96 [95% CI, 0.91-1.02] for social work) for the outcome of transplant.Conclusions and RelevanceAdolescents and young adults receiving care at dialysis facilities with higher patient to staff ratios had reduced access to waitlisting and transplant, particularly if they were younger than 22 years of age at dialysis initiation.

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

Cited by 5 publications

References 24 publications

A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study

A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study

Patient Care Technician Staffing and Outcomes Among US Patients Receiving In-Center Hemodialysis

Dialysis Facility Staffing Ratios and Kidney Transplant Access Among Adolescents and Young Adults

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