Readmission among Patients Receiving Dialysis Before and After DialysisConnect Rollout by High Utilizer Status Open Access

Abstract

Background: Hospital readmissions among patients receiving dialysis are associated with inadequate coordination of care, which is at least partially due to the substantial lack of electronic health record interoperability between U.S. dialysis facilities and hospitals. To address this gap, a web-based communications platform, DialysisConnect, was developed and piloted. Here, we examined whether this intervention had a differential effect on health outcomes between high utilizers (patients who account for a significant proportion of dialysis-related health care costs and hospital readmissions) and other patients.

Methods: DialysisConnect was tested in a pre-post pilot study conducted at Emory University Hospital Midtown (EUHM) and four Emory-affiliated dialysis clinics in Atlanta. Characteristics of all hospital admissions (n=1046) during the study period were compared by high utilizer status at admission (at least three hospital admissions or observation stays in the prior year) and by pilot (11/1/20-5/31/21) vs. pre-pilot (1/1/19-10/31/20) period. Interrupted time series, difference-in-difference (DID) analyses, and index admission-level linear regression, with adjustment for age, sex, race, and Charlson comorbidity index, were performed for primary (30-day hospital readmission) and secondary (30-day observation stay, 30-day emergency department (ED) visit, hospital length of stay, 30-day mortality) outcomes.

Results: The adjusted 30-day readmission rate among high utilizer admissions was higher in the pilot period after DialysisConnect was introduced vs. the pre-pilot (35.9% vs. 27.0%). In contrast, 30-day readmissions after non-high utilizer admissions were lower in the pilot vs. pre-pilot period among non-high utilizer admissions (14.0% vs. 20.2%). The primary outcome in 30-day readmission rates by high utilizer status was associated with a statistically significant DID value of 14.2%. We found opposite and statistically significant trends for 30-day observation stays/ED visits and 30-day observation stays alone, with lower rates among high utilizer admissions and higher rates among non-high utilizer admissions after the pilot period.

Conclusion: DialysisConnect was associated with lower 30-day readmission among non-high utilizers and higher 30-day readmission among high utilizers. Future studies should examine the effectiveness of such platforms embedded within multi-component, patient-centered interventions and also address who could most effectively serve as care coordinators for dialysis, particularly those who are high utilizers of the healthcare system.

Table of Contents

Background..................................................1

Chronic Kidney Disease..................................................1

End Stage Renal Disease and Dialysis..................................................2

Delivery of Dialysis Care in the U.S...................................................3

Hospital Readmissions..................................................4

Challenges in Dialysis Care Coordination..................................................5

DialysisConnect..................................................6

High Utilizers..................................................7

Study Aims..................................................9

Hypothesis..................................................9

Methods..................................................10

Study Design and Data Sources..................................................10

Variables..................................................10

Statistical Analysis..................................................12

Results..................................................14

Characteristics of Index Inpatient Admissions..................................................14

Readmissions Before and After DialysisConnect Rollout at the Monthly Level..................................................15

Readmissions Before and After DialysisConnect Rollout at the Admissions Level..................................................16

Discussion..................................................18

References..................................................27

Tables and Figures..................................................32

About this Honors Thesis

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School	Emory College
Department	Human Health
Degree	B.A.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, Health Care Management Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Chronic Kidney Disease Dialysis End Stage Renal Disease Health Services
Committee Chair / Thesis Advisor	Plantinga, Laura, Emory University
Committee Members	Welkley, Jill, Emory University Heemstra, John, Emory University Idler, Ellen, Emory University

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