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Hospital utilization among chronic dialysis patients
Pradeep Arora1, Annamaria T Kausz1, Gregorio T Obrador2,1
1Division of Nephrology, New England Medical Center, Tupper Research Institute, Tufts University School of Medicine and Dialysis Clinic, Inc., Boston, Massachusetts.
Journal of the American Society of Nephrology : JASN
|April 7, 2000
Summary
Patients initiating dialysis for chronic renal failure experienced higher hospital utilization in the first three months. Timely nephrologist referral and permanent vascular access placement can reduce hospital days and costs.
Area of Science:
- Nephrology
- Healthcare Management
- Health Economics
Background:
- Inpatient and outpatient utilization are significant cost drivers in chronic renal failure dialysis.
- Understanding factors influencing healthcare resource use is crucial for optimizing patient care and managing costs.
Purpose of the Study:
- To investigate factors associated with inpatient and outpatient utilization among new dialysis patients.
- To identify specific clinical and demographic predictors of healthcare resource consumption during the initial phase of dialysis.
Main Methods:
- Retrospective analysis of clinical, laboratory, and hospital resource utilization data.
- Study included patients initiating dialysis for chronic renal failure at New England Medical Center (1992-1997).
- Data collected from patient records and electronic databases, calculating utilization per patient year at risk (PYAR).
Main Results:
- Overall utilization: 2.2 hospitalizations and 14.8 hospital days per PYAR.
- Higher utilization in the first 3 months (4.3 hospitalizations, 28.3 days/PYAR) versus after 3 months (1.9 hospitalizations, 12.9 days/PYAR).
- Factors for early high utilization included non-HMO insurance, ischemic heart disease, late nephrologist referral, and temporary vascular access.
Conclusions:
- Hospital utilization is significantly higher in the initial 3 months of dialysis.
- Delayed nephrologist referral and lack of permanent vascular access are key predictors of increased early hospital utilization.
- Improved timely referral and vascular access placement may lead to reduced healthcare utilization and cost savings.