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Readmission due to pulmonary edema in hemodialysis patients

血液透析患者因肺水肿再入院

基本信息

批准号：
9339631
负责人：
Laura Plantinga
金额：
$ 4.98万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9339631
关键词：
Readmission due pulmonary edema hemodialysis

项目摘要

PROJECT SUMMARY U.S. end-stage renal disease patients account for a substantial proportion of Medicare expenditures, due to their large numbers (>650,000) and high levels of healthcare utilization. More than one-third of hospitalizations in end-stage renal disease patients who are treated with hemodialysis result in a readmission within 30 days. With the primary goal of improving patient-centered outcomes and reducing costs, the Centers for Medicare & Medicaid Services has prioritized reduction of hospital readmissions in dialysis patients. Despite this, few U.S. studies have explored readmissions, particularly cause-specific readmissions, in dialysis patients. Pulmonary edema (PE), also known as fluid overload, is common in hemodialysis patients. Ultrafiltration during hemodialysis should prevent these episodes, but patient lack of adherence to salt and fluid intake restrictions and to prescribed dialysis and difficulties in provider assessment current fluid status and dry weight can lead to PE. Additionally, patients who have recently been hospitalized may experience changes in their dry weight, change or add medications, and/or change their fluid intake, which may result in high risk for early readmission due to PE. Many investigators, including our group, have noted that dialysis providers could help reduce readmission risk via behaviors that could prevent PE and associated complications, such as more rapid acquisition and review of hospital records for patients returning to the dialysis facility, reassessment of dry weight, and reconciliation of medications. However, evidence for the association of these behaviors with reduced risk of readmission is limited. Using publicly available data from the United States Renal Data System (including Medicare inpatient and outpatient claims) as well as rich electronic medical record and chart data from 19 independent dialysis clinics affiliated with Emory University and Wake Forest University, we aim to: (1) estimate the national burden of, and identify correlates of, readmissions and ED visits within 30 days of an index hospitalization due to PE among U.S. hemodialysis patients; and (2) estimate associations between post-index hospitalization provider behaviors and risk of 30-day readmission and ED visits due to PE in a Southeastern dialysis population. The results from Aim 1 will inform national policy in the dialysis population by examining the burden of often-preventable readmissions and by identifying patient factors that may substantially contribute to facility-level readmissions performance, which will be pay-for-performance in 2017. The results from Aim 2 will inform a prospective pragmatic trial of a targeted provider behavior intervention to reduce readmissions related to PE in Southeastern dialysis patients treated at independent facilities. Such an intervention could be adapted and used both regionally and nationally to reduce the overall burden of hospital readmissions among dialysis patients, increase equity in outcomes among patients at high risk for readmissions, help dialysis facilities meet quality benchmarks, and lower costs of dialysis.

项目摘要美国终末期肾病患者占医疗保险支出的很大一部分，由于他们人数众多（> 650，000），医疗保健利用率高。超过三分之一的住院病例在终末期肾病患者中，血液透析治疗导致30天内再次入院。随着改善以患者为中心的结果和降低成本的主要目标，医疗保险和 Medicaid Services已优先考虑减少透析患者的再入院率。尽管如此，美国少数研究已经探索了透析患者的再入院，特别是原因特异性再入院。肺水肿（PE），也称为液体超负荷，在血液透析患者中很常见。超滤期间血液透析可以预防这些事件，但患者缺乏对盐和液体摄入限制的依从性，以及规定的透析和提供者评估当前液体状态和干重的困难可能导致体育课此外，最近住院的患者可能会经历干体重的变化，改变或增加药物和/或改变液体摄入量，这可能导致早期再入院的高风险因为PE。包括我们小组在内的许多调查人员都注意到，透析提供者可以帮助减少通过可以预防PE和相关并发症的行为，例如更快速地收集和审查返回透析机构的患者的医院记录，重新评估干体重和药物的协调。然而，证据表明，这些行为与再入院风险的降低是有限的。使用美国肾脏数据系统的公开可用数据（包括Medicare住院和门诊索赔）以及丰富的电子病历和图表数据来自埃默里大学和维克森林大学附属的19家独立透析诊所，我们的目标是：（1）估计国家负担，并确定相关的，再入院和艾德访问在30天内，美国血液透析患者中因PE导致的指数住院;（2）估计指数住院后医疗服务提供者行为以及因PE导致30天再入院和艾德就诊的风险东南部透析人群。目标1的结果将为透析人群的国家政策提供信息，检查经常可预防的再入院的负担，并确定可能大大有助于设施一级的再入院业绩，这将是按业绩支付在2017年。目标2的结果将为有针对性的提供者行为干预的前瞻性务实试验提供信息，减少在独立机构接受治疗的东南部透析患者中与PE相关的再入院。这样的可以在区域和国家两级调整和使用干预措施，以减少医院的总体负担。透析患者中的再入院率，增加高风险患者结局的公平性，帮助透析设施达到质量基准，并降低透析成本。