ORLANDO, Fla.—Rates of emergency department encounters (EDE) and observation stays (OBS) among hemodialysis patients have now exceeded hospitalization rates, investigators reported at the National Kidney Foundation’s 2017 Spring Clinical Meetings.
David T. Gilbertson, PhD, of the Chronic Disease Research Group, Minneapolis Medical Research Foundation, and investigators with the Peer Kidney Care Initiative analyzed the Centers for Medicare & Medicaid Services end-stage renal disease data from 2004 to 2013. They created yearly cohorts during that period comprising patients who were on dialysis and covered by Medicare Part A on January 1 of that year.
The number of prevalent hemodialysis patients increased from 249,439 in 2004 to 374,971 in 2013. From 2004 to 2013, the hospitalization rate decreased from 206 to 164 per 100 patient-years, whereas EDE/OBS rates increased from 166 to 200 per 100 patient-years.
The combined burden of hospitalizations or EDE/OBS was relatively constant until 2011, and then dipped slightly thereafter, reaching 350 per 100 patient-years in 2013, Dr Gilbertson’s group reported.
The study also showed that cause-specific patterns differed for cardiovascular disease (CVD) versus infection as primary diagnosis. CVD-related EDE/OBS visits increased 45% from 2004 to 2013, whereas infection EDE/OBS visits increased 23%. CVD hospitalizations decreased 36% and infection-related hospitalizations decreased 20%.
“Long-term declines in hospitalization rates are seen in the general Medicare population as well as the dialysis population,” Dr Gilbertson told Renal & Urology News. “Recent declines may be impacted by the Hospital Readmission Reduction Program. In turn, care previously delivered in an inpatient setting may now be delivered in and emergency department or observation-stay setting.”
He continued, “While this rather dramatic change may have occurred in part due to overall declining trends in hospitalization rates as well as hospital lengths of stay, the consequences of this change on patient outcomes is relatively unknown.”
See more coverage from the National Kidney Foundation Spring Clinical meeting.
Gilbertson DT, Peer Kidney Care Initiative Investigators. Trends in hospitalization, emergency dept. encounters, and observation stays in prevalence hemodialysis patients. Poster presented at the National Kidney Foundation’s 2017 Spring Clinical Meetings. Poster 211.