Background
Methods
Study population and data sources
Study variables
Readmissions
Dialysis facility processes of care
Covariates
Statistical analysis
Results
Characteristics of patients, index admissions, and readmissions
Characteristic | Overall | 30-day readmission status |
P*
| ||
---|---|---|---|---|---|
None | Pulmonary edema-related readmission | Any other readmission | |||
N
|
1056
|
869 (82.3%)
|
84 (8.0%)
|
103 (9.8%)
|
–
|
Index admission** characteristic | |||||
Median length of stay (IQR), days | 4 (2–7) | 4 (2–7) | 4 (2–7) | 5 (2–8) | 0.48 |
Pulmonary edema-related (%) | 38.8% | 37.7% | 76.2 | 17.5% | < 0.001 |
Intensive care utilization (%) | 23.9% | 24.3% | 20.2% | 23.3% | 0.74 |
Patient demographics | |||||
Mean (SD) age, years | 60.5 (15.0) | 60.4 (14.9) | 62.4 (15.4) | 58.5 (15.3) | 0.20 |
Female (%) | 47.8% | 47.2% | 50.0% | 51.5% | 0.65 |
Race/ethnicity (%) | 0.14 | ||||
Non-Hispanic white | 33.9% | 33.0% | 45.2% | 32.4% | |
Non-Hispanic black | 63.5% | 64.2% | 54.8% | 64.7% | |
Hispanic or other | 2.6% | 2.8% | 0.0% | 2.9% | |
Patient clinical factors | |||||
Median (IQR) dialysis vintage, years | 1.0 (0.3–3.9) | 1.1 (0.3–3.8) | 1.0 (0.3–4.0) | 0.7 (0.2–4.5) | 0.30 |
History of dialysis non-adherence | 3.4% | 2.6% | 7.1% | 5.8% | 0.02 |
Primary assigned cause of ESRD (%) | > 0.9 | ||||
Diabetes | 40.9% | 41.2% | 38.1% | 39.8% | |
Hypertension | 27.6% | 27.3% | 29.8% | 28.2% | |
Glomerulonephritis | 11.4% | 11.3% | 13.1% | 10.7% | |
Other | 20.2% | 20.2% | 19.1% | 21.4% | |
Comorbid conditions (%): | |||||
Diabetes | 59.8% | 60.3% | 54.8% | 60.2% | 0.62 |
Ischemic heart disease | 27.3% | 27.1% | 34.5% | 23.3% | 0.22 |
Hypertension | 98.9% | 98.8% | 98.8% | 100% | 0.71 |
Congestive heart failure | 42.4% | 40.8% | 73.8% | 28.2% | < 0.001 |
Post-index hospitalization dialysis facility processes of care and readmissions
Dialysis facility process of carea | No readmission | Pulmonary edema-related readmission | Other readmission |
P
|
---|---|---|---|---|
Index admission documented | ||||
% documented | 62.5% | 84.5% | 80.6% |
< 0.001
|
Unadjusted OR (95% CI) | ---c | 3.28 (1.79–6.02) | 2.49 (1.50–4.14) |
< 0.001/< 0.001
|
Adjustedb OR (95% CI) | ---c | 2.03 (1.07–3.85) | 1.48 (0.87–2.49) |
0.03/0.1
|
% patients with CHF documented in problem list at index discharge (among n = 389 patients with CHF history) | ||||
% yes | 39.9% | 56.5% | 17.2% |
0.001
|
Unadjusted OR (95% CI) | ---c | 1.95 (1.12–3.39) | 0.31 (0.12–0.84) |
0.02/0.02
|
Adjustedb OR (95% CI) | ---c | 1.87 (1.07–3.27) | 0.35 (0.13–0.96) |
0.03/0.04
|
% any labs drawn within 3 sessions after index discharge | ||||
% yes | 65.7% | 83.3% | 81.6% |
< 0.001
|
Unadjusted OR (95% CI) | ---c | 2.61 (1.45–4.71) | 2.31 (1.38–3.87) |
0.001/0.002
|
Adjustedb OR (95% CI) | ---c | 1.38 (0.74–2.56) | 1.32 (0.77–2.26) |
0.3/0.3
|
% albumin checked within 3 sessions after index discharge | ||||
% yes | 33.0% | 36.9% | 49.5% |
0.004
|
Unadjusted OR (95% CI) | ---c | 1.19 (0.74–1.89) | 1.99 (1.32–3.00) |
0.5/0.001
|
Adjustedb OR (95% CI) | ---c | 0.88 (0.54–1.42) | 1.61 (1.06–2.45) |
0.6/0.03
|
% hemoglobin/hematocrit checked within 3 sessions after index discharge | ||||
% yes | 59.4% | 79.8% | 76.7% |
< 0.001
|
Unadjusted OR (95% CI) | ---c | 2.70 (1.56–4.67) | 2.25 (1.40–3.63) |
< 0.001/0.001
|
Adjustedb OR (95% CI) | ---c | 1.65 (0.93–2.93) | 1.44 (0.88–2.35) |
0.08/0.1
|
% decrease in post-dialysis weight in the first 3 sessions of at least 0.5 kg | ||||
% yes | 56.6% | 50.0% | 55.3% |
0.5
|
Unadjusted OR (95% CI) | ---c | 0.77 (0.49–1.20) | 0.95 (0.63–1.43) |
0.2/0.8
|
Adjustedb OR (95% CI) | ---c | 0.60 (0.37–0.96) | 1.10 (0.72–1.67) |
0.03/0.7
|
% higher ESA dose ordered in first 3 sessions (among n = 282 with ESA administered) | ||||
% yes | 16.7% | 15.0% | 10.0% |
0.6
|
Unadjusted OR (95% CI) | ---c | 0.88 (0.25–3.16) | 0.56 (0.19–1.66) |
0.8/0.3
|
Adjustedb OR (95% CI) | ---c | 0.88 (0.24–3.27) | 0.57 (0.19–1.71) |
0.8/0.3
|
% any home medication discontinued in first 3 sessions | ||||
% yes | 16.1% | 31.0% | 20.4% |
0.002
|
Unadjusted OR (95% CI) | ---c | 2.33 (1.42–3.84) | 1.33 (0.80–2.23) |
0.001/0.3
|
Adjustedb OR (95% CI) | ---c | 1.81 (1.08–3.05) | 1.20 (0.71–2.02) |
0.02/0.5
|
% any home medication changed in first 3 sessions | ||||
% yes | 27.6% | 41.2% | 21.3% |
0.004
|
Unadjusted OR (95% CI) | ---c | 1.84 (1.19–2.82) | 0.71 (0.45–1.11) |
0.006/0.1
|
Adjustedb OR (95% CI) | ---c | 1.69 (1.06–2.70) | 0.75 (0.47–1.20) |
0.003/0.2
|
% index discharge occurring at facility with current ultrafiltration rate policyd | ||||
% yes | 30.3% | 19.1% | 19.4% |
0.01
|
Unadjusted OR (95% CI) | ---c | 0.55 (0.31–0.96) | 0.56 (0.34–0.93) |
0.04/0.03
|
Adjustedb OR (95% CI) | ---c | 0.75 (0.42–1.36) | 0.80 (0.47–1.35) |
0.3/0.4
|