Hospital utilization among chronic dialysis patients.
Factors driving inpatient and outpatient utilization were studied among patients who began dialysis for chronic renal failure at the New England Medical Center (NEMC) between 1992 and 1997. Clinical, laboratory, and hospital resource utilization data were obtained from patient records and electronic databases. There were 2.2 hospitalizations and 14.8 hospital days per patient year at risk (PYAR). The number of hospitalizations and hospital days per PYAR were higher in the first 3 mo of initiating dialysis (4.3 and 28.3, respectively) compared to after 3 mo (1.9 and 12.9, respectively). Factors associated with increased risk of hospital days within the first 3 mo included non-health maintenance organization insurance, ischemic heart disease, late referral to the nephrologist, and use of temporary vascular access for the first dialysis. Patients with ischemic heart disease and who received dialysis during the years 1992-1994 compared with 1996-1997 had an increased risk of hospital days after 3 mo of initiating dialysis. There were 16.6 outpatient visits per PYAR, with significant differences in utilization between the first 3 mo and after 3 mo of initiating dialysis. Thus, hospital utilization was significantly higher in the first 3 mo compared to after 3 mo, and factors associated with hospital utilization depended on duration of dialysis. In particular, delayed referral to the nephrologist and lack of permanent vascular access were independently associated with increased risk of hospital utilization in the first 3 mo of dialysis. Greater attention to timely referral to the nephrologist and timely placement of vascular access could result in reduced utilization and cost savings.
Arora
Pradeep
P
Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Kausz
Annamaria T
AT
Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Obrador
Gregorio T
GT
Panamerican University School of Medicine, Mexico City, Mexico.|Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Ruthazer
Robin
R
Division of Clinical Care Research, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Khan
Samina
S
Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Jenuleson
Constance S
CS
Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Meyer
Klemens B
KB
Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Pereira
Brian J G
BJG
Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000150:complications; D005260:Female; D006279:Health Maintenance Organizations; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009398:Nephrology / Q000379:methods; D010530:Peritoneal Dialysis; D012017:Referral and Consultation; D006435:Renal Dialysis; D013997:Time Factors