Emergency-Only Dialysis Utilization at Grady Memorial Hospital and Emory Hospitals Open Access
Reiss, Hannah (Spring 2023)
Abstract
Background: End-stage renal disease (ESRD) is the most advanced stage of chronic kidney disease (CKD) and necessitates dialysis. In the United States, undocumented individuals do not have access to scheduled dialysis, resorting to emergency dialysis under EMTALA, an arrangement which results in higher morbidity and mortality rates compared to those with scheduled treatments. Additionally, emergency-only dialysis is more costly than scheduled dialysis, creating an economic argument for providing scheduled dialysis to undocumented individuals with ESRD.
Methods: This was a cross-sectional study to assess the frequency of emergency-only dialysis visits, cost, and duration of stay for undocumented ESRD patients at one public and two private hospitals affiliated with Emory University. The study employed univariate and multivariable linear regression models and Lorenz curves.
Results: Patients who relied on emergency-only dialysis had an average of 49.4 annual visits at the public hospital and 8.1 annual visits at the private hospitals. The average expense per visit across all hospitals was $1,363. In the model comparing costs between the two private hospitals, the predicted cost per visit at EUH was $1,492, while at SJH it was $998, with age and sex being significant cost predictors. For visit frequency, cost, and length of stay, the Gini coefficients at the public hospital were consistently lower than those at the private hospitals.
Conclusion: These results highlight the resource-intensive nature of emergency-only dialysis at all the hospitals in the study. This leads to wide-ranging consequences and challenges for healthcare providers and patients alike.
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Table of Contents
Table of Contents
BACKGROUND
METHODS
RESULTS
DISCUSSION
LIMITATIONS
CONCLUSIONS
TABLE 1: GENERAL DEMOGRAPHICS
TABLE 2: GINI COEFFICIENTS
FIGURE 1
FIGURE 2
FIGURE 3
WORKS CITED
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