title: Dedicated outpatient vascular access center decreases hospitalization and missed outpatient dialysis treatments.
abstract: Dedicated outpatient vascular access centers (VAC) specializing in percutaneous interventions (angiography, thrombectomy, angioplasty and catheter placement) provide outpatient therapy that can obviate the need for hospitalization. This paper reports the impact of one VAC staffed by interventional nephrologists on vascular access-related hospitalization and missed outpatient dialysis treatments. We performed a retrospective analysis of vascular access-related hospitalized days and missed vascular access-related outpatient dialysis treatments from 1995 to 2002 in 21 Phoenix Arizona Facilities (5928 cumulative patients) and 1275 cumulative Fresenius Medical Care North America (FMCNA) facilities (289,454 cumulative patients) to evaluate the impact of the introduction of a VAC in Phoenix. Vascular access-related hospitalized days/patient year and missed dialysis treatments/patient year declined from 1997 to 2002 across all access types. The decline was greater in Phoenix and coincided with the creation of a VAC in 1998. By 2002, there were 0.57 fewer hospitalized days/patient year and 0.29 fewer missed treatments/patient year than in the national sample (P<0.01). In 2002, the relative risk for vascular access hospitalized days was 0.38 (95% confidence interval (CI) 0.27-0.5) (P<0.01) and for vascular access-related missed outpatient dialysis treatments was 0.34 (95% CI 0.24-0.49) (P<0.01) in Phoenix vs FMCNA after adjustment for age, gender, diabetic status duration of dialysis and access type. VAC development was associated with a significant decrease in vascular access-related hospitalization and missed outpatient dialysis treatments. Further studies are necessary to demonstrate this effect in other communities.
authors.affiliation: Arizona Kidney Disease and Hypertension Center, Phoenix, Arizona 85102, USA. rmishler@pol.net
authors.forename: R
authors.initials: R
authors.lastname: Mishler
authors.forename: J J
authors.initials: JJ
authors.lastname: Sands
authors.forename: N J
authors.initials: NJ
authors.lastname: Ofsthun
authors.forename: M
authors.initials: M
authors.lastname: Teng
authors.forename: D
authors.initials: D
authors.lastname: Schon
authors.forename: J M
authors.initials: JM
authors.lastname: Lazarus
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis