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.

项目摘要由于它们的大量（> 650,000）和高水平的医疗保健利用。超过三分之一的住院在末期肾脏疾病患者中，接受血液透析治疗的患者在30天内导致再入院。 Medicare＆医疗补助服务已优先减少透析患者的医院再入院。尽管如此，美国很少研究探索了透析患者的再入院，尤其是引起特定的再入院。肺水肿（PE），也称为液体超负荷，在血液透析患者中很常见。超滤期间血液透析应预防这些发作，但患者缺乏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的困难当前的流体状态和干重可能导致 PE。此外，最近住院的患者可能会发生干重的变化，更改或添加药物和/或更改其液体摄入量，这可能会导致早期再入院的高风险由于PE。包括我们小组在内的许多调查人员指出，透析提供者可以帮助减少通过可能阻止PE和相关并发症的行为的再入院风险，例如更快收购和审查返回透析设施的患者的医院记录，重新评估干燥体重和药物的和解。但是，这些行为与降低的再入院风险是有限的。使用美国肾脏数据系统的公开数据（包括医疗保险住院和门诊索赔）以及丰富的电子病历和图表数据从埃默里大学和维克森林大学隶属的19个独立透析诊所，我们的目标是：（1）估计国家负担的全国负担，并确定在30天内的30天内的再入院和ED访问美国血液透析患者中PE导致的指数住院；（2）估计关联索引后住院提供者的行为以及30天再入院的风险和eD访问的风险东南透析人群。 AIM 1的结果将通过检查通常可以预防再入院的负担，并通过确定可能的患者因素实质上有助于设施级别的再入院性能，这将是2017年的绩效。 AIM 2的结果将为有针对性提供者行为干预的潜在务实试验提供信息减少在独立设施治疗的东南透析患者中与PE相关的再入院。这样的可以在区域和全国范围内调整干预措施，以减轻医院的整体负担透析患者的再入院，增加了高风险患者的股权再入院，帮助透析设施符合优质基准和较低的透析成本。