title: Dialysis Modality and Readmission Following Hospital Discharge: A Population-Based Cohort Study.
abstract: BACKGROUND
  Readmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readmission following discharge.
  
  
  METHODS
  Population-based retrospective-cohort observational study.
  
  
  METHODS
  Patients treated with maintenance dialysis who were discharged following an acute-care hospitalization during January 1, 2003, to December 31, 2013, across 164 acute-care hospitals in Ontario, Canada. For those with multiple hospitalizations, we randomly selected a single hospitalization as the index hospitalization.
  
  
  METHODS
  Dialysis modality PD or in-center HD. Propensity scores were used to match each patient on PD therapy to 2 patients on in-center HD therapy to ensure that baseline indicators of health were similar between the 2 groups.
  
  
  RESULTS
  All-cause 30-day readmission following the index hospital discharge.
  
  
  RESULTS
  28,026 dialysis patients were included in the study. 4,013 PD patients were matched to 8,026 in-center HD patients. Among the matched cohort, 30-day readmission rates were 7.1 (95% CI, 6.6-7.6) per 1,000 person-days for patients on PD therapy and 6.0 (95% CI, 5.7-6.3) per 1,000 person-days for patients on in-center HD therapy. The risk for a 30-day readmission among patients on PD therapy was higher compared with those on in-center HD therapy (adjusted HR, 1.19; 95% CI, 1.08-1.31). The primary results were consistent across several key prespecified subgroups.
  
  
  CONCLUSIONS
  Lack of information for the frequency of nephrology physician encounters following discharge from the hospital in both the PD and in-center HD cohorts. Limited validation of International Classification of Diseases, Tenth Revision codes.
  
  
  CONCLUSIONS
  The risk for 30-day readmission is higher for patients on home-based PD compared to in-center HD therapy. Interventions to improve transitions in care between the inpatient and outpatient settings are needed, particularly for patients on PD therapy.
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: jeff.perl@utoronto.ca.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: McArthur
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Chaim
authors.initials: C
authors.lastname: Bell
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
authors.affiliation: Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shai
authors.initials: S
authors.lastname: Harel
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lihua
authors.initials: L
authors.lastname: Li
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada.
authors.forename: Arsh K
authors.initials: AK
authors.lastname: Jain
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Nash
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ziv
authors.initials: Z
authors.lastname: Harel
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: 30-day readmission rate; Canada; Hemodialysis (HD); dialysis modality; hospital discharge; hospital readmission; hospitalization; in-center HD; peritoneal dialysis (PD)