title: Physician visits and 30-day hospital readmissions in patients receiving hemodialysis.
abstract: A focus of health care reform has been on reducing 30-day hospital readmissions. Patients with ESRD are at high risk for hospital readmission. It is unknown whether more monitoring by outpatient providers can reduce hospital readmissions in patients receiving hemodialysis. In nationally representative cohorts of patients in the United States receiving in-center hemodialysis between 2004 and 2009, we used a quasi-experimental (instrumental variable) approach to assess the relationship between frequency of visits to patients receiving hemodialysis following hospital discharge and the probability of rehospitalization. We then used a multivariable regression model and published hospitalization data to estimate the cost savings and number of hospitalizations that could be prevented annually with additional provider visits to patients in the month following hospitalization. In the main cohort (n=26,613), one additional provider visit in the month following hospital discharge was estimated to reduce the absolute probability of 30-day hospital readmission by 3.5% (95% confidence interval, 1.6% to 5.3%). The reduction in 30-day hospital readmission ranged from 0.5% to 4.9% in an additional four cohorts tested, depending on population density around facilities, facility profit status, and patient Medicaid eligibility. At current Medicare reimbursement rates, the effort to visit patients one additional time in the month following hospital discharge could lead to 31,370 fewer hospitalizations per year, and $240 million per year saved. In conclusion, more frequent physician visits following hospital discharge are estimated to reduce rehospitalizations in patients undergoing hemodialysis. Incentives for closer outpatient monitoring following hospital discharge could lead to substantial cost savings.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California kevine1@stanford.edu.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Erickson
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D018166:Health Care Reform / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics; D014481:United States