Discharge service as a determinant of 30-day readmission in a cohort of maintenance hemodialysis patients: A retrospective cohort study

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Abstract

Background: End stage renal disease (ESRD) patients on maintenance hemodialysis, are high utilizers of inpatient services. Because of data showing improved outcomes in medical patients admitted to hospitalist-run, non-Teaching services, we hypothesized that discharge from a hospitalist-run, non-Teaching service is associated with lower risk of 30-day re-hospitalization in a cohort of patients on hemodialysis. Methods: One thousand and 84 consecutive patients with ESRD on maintenance hemodialysis who were admitted to Montefiore, a tertiary care center, in 2014 were analyzed using the electronic medical records. We evaluated factors associated with 30-day readmission in multivariable regression models. We then tested the association of care by a hospitalist-run, non-Teaching service with 30-day readmission in a propensity score matched analysis. Results: Patients cared for on the hospitalist-run, non-Teaching service had lower socio-economic scores (SES) and had longer lengths of stay (LOS), as compared to a standard teaching service, but otherwise the populations were similar. In multivariable testing, severity of illness, (OR 2.40, (95%CI: 1.43-4.03) for highest quartile) number of previous hospitalizations (OR 1.22 (95%CI:1.16-1.28) for each admission), and discharge to a skilled nursing facility (SNF)(OR 1.56 (95%CI:1.01-2.43) were significantly associated with 30-day re-Admissions. Care by the non-Teaching service was associated with a lower risk of 30-day readmission, even after adjusting for clinical factors and matching based on propensity score (OR 0.65(95%CI:0.46-0.91) and 0.71(95%CI:0.66-0.77) respectively). Conclusions: Patients with ESRD on hemodialysis discharged from a hospitalist-run, non-Teaching medicine service had lower odds of readmission as compared to those patients discharged from a standard teaching service.

Original languageEnglish (US)
Article number352
JournalBMC Nephrology
Volume18
Issue number1
DOIs
StatePublished - Dec 4 2017

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Hospitalists
Renal Dialysis
Cohort Studies
Retrospective Studies
Maintenance
Chronic Kidney Failure
Propensity Score
Teaching
Hospitalization
Skilled Nursing Facilities
Electronic Health Records
Tertiary Care Centers
Inpatients
Length of Stay
Economics
Medicine
Population

Keywords

  • Dialysis hospitalization teaching service

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{533a2691532c4b13b740b92365fc8cce,
title = "Discharge service as a determinant of 30-day readmission in a cohort of maintenance hemodialysis patients: A retrospective cohort study",
abstract = "Background: End stage renal disease (ESRD) patients on maintenance hemodialysis, are high utilizers of inpatient services. Because of data showing improved outcomes in medical patients admitted to hospitalist-run, non-Teaching services, we hypothesized that discharge from a hospitalist-run, non-Teaching service is associated with lower risk of 30-day re-hospitalization in a cohort of patients on hemodialysis. Methods: One thousand and 84 consecutive patients with ESRD on maintenance hemodialysis who were admitted to Montefiore, a tertiary care center, in 2014 were analyzed using the electronic medical records. We evaluated factors associated with 30-day readmission in multivariable regression models. We then tested the association of care by a hospitalist-run, non-Teaching service with 30-day readmission in a propensity score matched analysis. Results: Patients cared for on the hospitalist-run, non-Teaching service had lower socio-economic scores (SES) and had longer lengths of stay (LOS), as compared to a standard teaching service, but otherwise the populations were similar. In multivariable testing, severity of illness, (OR 2.40, (95{\%}CI: 1.43-4.03) for highest quartile) number of previous hospitalizations (OR 1.22 (95{\%}CI:1.16-1.28) for each admission), and discharge to a skilled nursing facility (SNF)(OR 1.56 (95{\%}CI:1.01-2.43) were significantly associated with 30-day re-Admissions. Care by the non-Teaching service was associated with a lower risk of 30-day readmission, even after adjusting for clinical factors and matching based on propensity score (OR 0.65(95{\%}CI:0.46-0.91) and 0.71(95{\%}CI:0.66-0.77) respectively). Conclusions: Patients with ESRD on hemodialysis discharged from a hospitalist-run, non-Teaching medicine service had lower odds of readmission as compared to those patients discharged from a standard teaching service.",
keywords = "Dialysis hospitalization teaching service",
author = "Ladan Golestaneh and Eran Bellin and William Southern and Melamed, {Michal L.}",
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doi = "10.1186/s12882-017-0761-9",
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volume = "18",
journal = "BMC Nephrology",
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T1 - Discharge service as a determinant of 30-day readmission in a cohort of maintenance hemodialysis patients

T2 - A retrospective cohort study

AU - Golestaneh, Ladan

AU - Bellin, Eran

AU - Southern, William

AU - Melamed, Michal L.

PY - 2017/12/4

Y1 - 2017/12/4

N2 - Background: End stage renal disease (ESRD) patients on maintenance hemodialysis, are high utilizers of inpatient services. Because of data showing improved outcomes in medical patients admitted to hospitalist-run, non-Teaching services, we hypothesized that discharge from a hospitalist-run, non-Teaching service is associated with lower risk of 30-day re-hospitalization in a cohort of patients on hemodialysis. Methods: One thousand and 84 consecutive patients with ESRD on maintenance hemodialysis who were admitted to Montefiore, a tertiary care center, in 2014 were analyzed using the electronic medical records. We evaluated factors associated with 30-day readmission in multivariable regression models. We then tested the association of care by a hospitalist-run, non-Teaching service with 30-day readmission in a propensity score matched analysis. Results: Patients cared for on the hospitalist-run, non-Teaching service had lower socio-economic scores (SES) and had longer lengths of stay (LOS), as compared to a standard teaching service, but otherwise the populations were similar. In multivariable testing, severity of illness, (OR 2.40, (95%CI: 1.43-4.03) for highest quartile) number of previous hospitalizations (OR 1.22 (95%CI:1.16-1.28) for each admission), and discharge to a skilled nursing facility (SNF)(OR 1.56 (95%CI:1.01-2.43) were significantly associated with 30-day re-Admissions. Care by the non-Teaching service was associated with a lower risk of 30-day readmission, even after adjusting for clinical factors and matching based on propensity score (OR 0.65(95%CI:0.46-0.91) and 0.71(95%CI:0.66-0.77) respectively). Conclusions: Patients with ESRD on hemodialysis discharged from a hospitalist-run, non-Teaching medicine service had lower odds of readmission as compared to those patients discharged from a standard teaching service.

AB - Background: End stage renal disease (ESRD) patients on maintenance hemodialysis, are high utilizers of inpatient services. Because of data showing improved outcomes in medical patients admitted to hospitalist-run, non-Teaching services, we hypothesized that discharge from a hospitalist-run, non-Teaching service is associated with lower risk of 30-day re-hospitalization in a cohort of patients on hemodialysis. Methods: One thousand and 84 consecutive patients with ESRD on maintenance hemodialysis who were admitted to Montefiore, a tertiary care center, in 2014 were analyzed using the electronic medical records. We evaluated factors associated with 30-day readmission in multivariable regression models. We then tested the association of care by a hospitalist-run, non-Teaching service with 30-day readmission in a propensity score matched analysis. Results: Patients cared for on the hospitalist-run, non-Teaching service had lower socio-economic scores (SES) and had longer lengths of stay (LOS), as compared to a standard teaching service, but otherwise the populations were similar. In multivariable testing, severity of illness, (OR 2.40, (95%CI: 1.43-4.03) for highest quartile) number of previous hospitalizations (OR 1.22 (95%CI:1.16-1.28) for each admission), and discharge to a skilled nursing facility (SNF)(OR 1.56 (95%CI:1.01-2.43) were significantly associated with 30-day re-Admissions. Care by the non-Teaching service was associated with a lower risk of 30-day readmission, even after adjusting for clinical factors and matching based on propensity score (OR 0.65(95%CI:0.46-0.91) and 0.71(95%CI:0.66-0.77) respectively). Conclusions: Patients with ESRD on hemodialysis discharged from a hospitalist-run, non-Teaching medicine service had lower odds of readmission as compared to those patients discharged from a standard teaching service.

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