Predicting and preventing readmissions in kidney transplant recipients.
A lack of research exploring post-transplant process optimization to reduce readmissions and increasing readmission rates at our center from 2009 to 2013 led to this study, aimed at assessing the effect of patient and process factors on 30-d readmission rates after kidney transplantation. This was a retrospective case-control study in adult kidney transplant recipients. Univariate and multivariate analyses were utilized to assess patient and process determinants of 30-d readmissions. 384 patients were included; 30-d readmissions were significantly associated with graft loss and death (p = 0.001). Diabetes (p = 0.049), pharmacist identification of poor understanding or adherence, and prolonged time on hemodialysis prior to transplant were associated with an increased risk of 30-d readmissions. After controlling for risk factors, readmission rates were only independently predicted by pharmacist identification of patient lack of understanding or adherence regarding post-transplant medications and dialysis exposure for more than three yr (OR 2.3, 95% CI 1.10-4.71, p = 0.026 and OR 2.1, 95% CI 1.22, 3.70, respectively), both of which were significantly modified by history of diabetes. Thirty-d readmissions are attributable to both patient and process-level factors. These data suggest that a lack of post-transplant medication knowledge in high-risk patients drives early hospital readmission.
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Kelly L
KL
Covert
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
James N
JN
Fleming
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Carmelina
C
Staino
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Jillian P
JP
Casale
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Kimberly M
KM
Boyle
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Nicole A
NA
Pilch
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Holly B
HB
Meadows
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Caitlin R
CR
Mardis
Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
John W
JW
McGillicuddy
Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
Satish
S
Nadig
Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
Charles F
CF
Bratton
Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
Kenneth D
KD
Chavin
Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
Prabhakar K
PK
Baliga
Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.|Department of Pharmacy, Ralph H. Johnson VAMC, Charleston, SC, USA.
David J
DJ
Taber
D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D007902:Length of Stay / Q000639:trends; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
healthcare quality; hospital readmission; kidney transplantation; medication adherence; pharmacy