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

Understanding Hospital Readmissions: Insights, Patterns, and Interventions for Improvement in Chronic Kidney Disease

BACKGROUND

Hospital readmissions among chronic kidney disease (CKD) patients pose substantial challenges in healthcare, impacting both patients and healthcare systems. Understanding the patterns and determinants of CKD-related readmissions is crucial for devising effective interventions.

OBJECTIVE

This research aimed to investigate the factors contributing to hospital readmissions among CKD patients, identify the primary reasons for readmissions, and explore potential interventions to mitigate readmission risks.

METHODS

A retrospective analysis was conducted among a cohort of 300 CKD patients over an 18-month period at a tertiary care unit specializing in nephrology services. Data on demographics, CKD stages, comorbidities, reasons for readmissions, and lengths of hospital stays were analyzed. Logistic regression models were employed to identify predictors of readmissions.

RESULTS

Advancing CKD stages were associated with increased readmission rates, with higher rates observed in older patients. Cardiovascular complications and acute kidney injury were prominent reasons for readmissions. Age, comorbid conditions, and previous hospitalizations emerged as significant predictors of readmissions. Lengths of hospital stays during readmissions were also correlated with CKD stages.

CONCLUSION

The research underscores the complex interplay of demographic and clinical factors contributing to hospital readmissions among CKD patients. Tailored interventions addressing disease severity, comorbidities, and patient-specific characteristics are pivotal in reducing readmission risks and enhancing care outcomes for this population.

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

Importance

Dialysis 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.

Objective

To estimate the associations of in-center HD patient outcomes with facility-level PCT staffing.

Design, Setting, and Participants

This 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.

Exposure

Facility-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 Measures

Patient-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.

Results

A 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 Relevance

These 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.

A Web-based, Provider-driven Mobile App to Enhance Patient Care Coordination between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study (Preprint)

Background

Objective

Methods

Results

Conclusions