National Estimates of 30-Day Unplanned Readmissions of Patients on Maintenance Hemodialysis

Clinical journal of the American Society of Nephrology: CJASN

Lili Chan³  Aparna Saha⁴  Elizabeth Hammer⁵ 

[1] and..*Division of Nephrology, Department of Medicine,..‖Division of Population Health, and..¶Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York;*Division of Nephrology, Department of Medicine,..*Division of Nephrology, Department of Medicine,..;*Division of Nephrology, Department of Medicine,..*Division of Nephrology, Department of Medicine,..†Department of Public Health,..;†Department of Public Health,..;‡Division of Nephrology, Department of Medicine, New York University Lutheran Hospital, New York, New York

关键词: dialysis;    end stage kidney disease;    mortality;    Readmission;    Comorbidity;    depression;    Depressive Disorder;    hospitalization;    Humans;    hypertension;    Kidney Failure, Chronic;    Logistic Models;    Myocardial Infarction;    Odds Ratio;    Patient Discharge;    Patient Readmission;    renal dialysis;    Retrospective Studies;    Software;    Substance-Related Disorders;    Surveys and Questionnaires;   

DOI  :  10.2215/CJN.02600317

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Patients on hemodialysis have high 30-day unplanned readmission rates. Using a national all-payer administrative database, we describe the epidemiology of 30-day unplanned readmissions in patients on hemodialysis, determine concordance of reasons for initial admission and readmission, and identify predictors for readmission.Design, setting, participants, & measurements This is a retrospective cohort study using the Nationwide Readmission Database from the year 2013 to identify index admissions and readmission in patients with ESRD on hemodialysis. The Clinical Classification Software was used to categorize admission diagnosis into mutually exclusive clinically meaningful categories and determine concordance of reasons for admission on index hospitalizations and readmissions. Survey logistic regression was used to identify predictors of at least one readmission.Results During 2013, there were 87,302 (22%) index admissions with at least one 30-day unplanned readmission. Although patient and hospital characteristics were statistically different between those with and without readmissions, there were small absolute differences. The highest readmission rate was for acute myocardial infarction (25%), whereas the lowest readmission rate was for hypertension (20%). The primary reasons for initial hospitalization and subsequent 30-day readmission were discordant in 80% of admissions. Comorbidities that were associated with readmissions included depression (odds ratio, 1.10; 95% confidence interval [95% CI], 1.05 to 1.15; P<0.001), drug abuse (odds ratio, 1.41; 95% CI, 1.31 to 1.51; P<0.001), and discharge against medical advice (odds ratio, 1.57; 95% CI, 1.45 to 1.70; P<0.001). A group of high utilizers, which constituted 2% of the population, was responsible for 20% of all readmissions.Conclusions In patients with ESRD on hemodialysis, nearly one quarter of admissions were followed by a 30-day unplanned readmission. Most readmissions were for primary diagnoses that were different from initial hospitalization. A small proportion of patients accounted for a disproportionate number of readmissions.

【 授权许可】

CC BY