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Temporal Trends in the Complexity of Nephrology Inpatients: A Population-Based Cohort Study
Anukul Ghimire1, Natasha Wiebe2, Brenda R Hemmelgarn2
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Summary
The number of complex patients seen by nephrologists increased significantly from 2011-2020. Despite this rising complexity, nephrology patients experienced greater reductions in mortality and long-term care needs.
Area of Science:
- Nephrology
- Healthcare Management
- Public Health
Background:
- Clinical experience suggests increasing complexity among patients seen by nephrologists.
- This trend necessitates a comparison with other physician specialties to understand its scope.
Purpose of the Study:
- To compare temporal trends in patient complexity profiles between nephrology and other physician services.
- To assess changes in patient complexity markers and outcomes over a decade.
Main Methods:
- Retrospective-cohort study of adult inpatients in Alberta, Canada (2011-2020).
- Analysis included physician groups, calendar time, and ten pre-admission complexity markers.
- Generalized linear models were used to estimate changes in complexity and outcomes (death, long-term care placement).
Main Results:
- Nephrology inpatient volume increased by 44%, exceeding other specialties.
- Multiple complexity markers (e.g., number of caregivers, prescriptions, ED visits) significantly increased, with larger magnitudes in nephrology patients.
- Despite increased complexity, risks of death and long-term care placement decreased more substantially for nephrology patients.
Conclusions:
- Inpatient nephrology care volume and patient complexity have risen, independent of population aging.
- While complexity increased, nephrology care was associated with greater improvements in patient survival and reduced need for long-term care.
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