title: Inpatient and emergent resource use of patients on dialysis at an academic medical center.
abstract: OBJECTIVE
  End-stage renal disease patients require resources for emergent and inpatient care in addition to ambulatory dialysis. There are two dialysis modalities and settings which patients switch between. Our aim was to characterize the patterns and reasons for switching, as well as the emergent and inpatient utilization of these patients at the University Health Network.
  
  
  METHODS
  Patients who received chronic dialysis between March 1, 2006, and April 30, 2011, were identified. Utilization was measured by emergency department (ED) visits, inpatient hospitalizations, and bed-days occupied per year.
  
  
  RESULTS
  Out of 576 patients identified, 18.6% switched modality and/or setting. The majority of switches occurred during the first year of dialysis. Patients who switched had increased utilization compared to those on a continuous modality/setting. Overall, patients had a median rate of 0.91 ED visits per patient-year, compared to 1.56 for patients who switched modality and setting. Median inpatient bed resource requirement was 4.46 bed-days/patient-year overall, compared to 8.91 for patients who switched modality and setting.
  
  
  CONCLUSIONS
  Emergent and inpatient utilization is related to the setting and modality of dialysis, although differences are partly explained by comorbidities. Patients who switch modalities use more resources and may be a prime population for interventions.
authors.affiliation: The Centre for Innovation in Complex Care, University Health Network (UHN), Toronto, Ont., Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Chow
authors.forename: Hannah
authors.initials: H
authors.lastname: Wong
authors.forename: Shoshana
authors.initials: S
authors.lastname: Hahn-Goldberg
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.forename: Dante
authors.initials: D
authors.lastname: Morra
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002170:Canada; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006437:Hemodialysis, Home / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies