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Table 2 Associations of dialysis facility processes of care with pulmonary edema-related and other 30-day readmissions, among hospitalized Emory and Wake Forest hemodialysis patients in 1/2010–7/2015

From: Post-hospitalization dialysis facility processes of care and hospital readmissions among hemodialysis patients: a retrospective cohort study

Dialysis facility process of carea

No readmission

Pulmonary edema-related readmission

Other readmission

P

Index admission documented

 % documented

62.5%

84.5%

80.6%

< 0.001

 Unadjusted OR (95% CI)

---c

3.28 (1.79–6.02)

2.49 (1.50–4.14)

< 0.001/< 0.001

 Adjustedb OR (95% CI)

---c

2.03 (1.07–3.85)

1.48 (0.87–2.49)

0.03/0.1

% patients with CHF documented in problem list at index discharge (among n = 389 patients with CHF history)

 % yes

39.9%

56.5%

17.2%

0.001

 Unadjusted OR (95% CI)

---c

1.95 (1.12–3.39)

0.31 (0.12–0.84)

0.02/0.02

 Adjustedb OR (95% CI)

---c

1.87 (1.07–3.27)

0.35 (0.13–0.96)

0.03/0.04

% any labs drawn within 3 sessions after index discharge

 % yes

65.7%

83.3%

81.6%

< 0.001

 Unadjusted OR (95% CI)

---c

2.61 (1.45–4.71)

2.31 (1.38–3.87)

0.001/0.002

 Adjustedb OR (95% CI)

---c

1.38 (0.74–2.56)

1.32 (0.77–2.26)

0.3/0.3

% albumin checked within 3 sessions after index discharge

 % yes

33.0%

36.9%

49.5%

0.004

 Unadjusted OR (95% CI)

---c

1.19 (0.74–1.89)

1.99 (1.32–3.00)

0.5/0.001

 Adjustedb OR (95% CI)

---c

0.88 (0.54–1.42)

1.61 (1.06–2.45)

0.6/0.03

% hemoglobin/hematocrit checked within 3 sessions after index discharge

 % yes

59.4%

79.8%

76.7%

< 0.001

 Unadjusted OR (95% CI)

---c

2.70 (1.56–4.67)

2.25 (1.40–3.63)

< 0.001/0.001

 Adjustedb OR (95% CI)

---c

1.65 (0.93–2.93)

1.44 (0.88–2.35)

0.08/0.1

% decrease in post-dialysis weight in the first 3 sessions of at least 0.5 kg

 % yes

56.6%

50.0%

55.3%

0.5

 Unadjusted OR (95% CI)

---c

0.77 (0.49–1.20)

0.95 (0.63–1.43)

0.2/0.8

 Adjustedb OR (95% CI)

---c

0.60 (0.37–0.96)

1.10 (0.72–1.67)

0.03/0.7

% higher ESA dose ordered in first 3 sessions (among n = 282 with ESA administered)

 % yes

16.7%

15.0%

10.0%

0.6

 Unadjusted OR (95% CI)

---c

0.88 (0.25–3.16)

0.56 (0.19–1.66)

0.8/0.3

 Adjustedb OR (95% CI)

---c

0.88 (0.24–3.27)

0.57 (0.19–1.71)

0.8/0.3

% any home medication discontinued in first 3 sessions

 % yes

16.1%

31.0%

20.4%

0.002

 Unadjusted OR (95% CI)

---c

2.33 (1.42–3.84)

1.33 (0.80–2.23)

0.001/0.3

 Adjustedb OR (95% CI)

---c

1.81 (1.08–3.05)

1.20 (0.71–2.02)

0.02/0.5

% any home medication changed in first 3 sessions

 % yes

27.6%

41.2%

21.3%

0.004

 Unadjusted OR (95% CI)

---c

1.84 (1.19–2.82)

0.71 (0.45–1.11)

0.006/0.1

 Adjustedb OR (95% CI)

---c

1.69 (1.06–2.70)

0.75 (0.47–1.20)

0.003/0.2

% index discharge occurring at facility with current ultrafiltration rate policyd

 % yes

30.3%

19.1%

19.4%

0.01

 Unadjusted OR (95% CI)

---c

0.55 (0.31–0.96)

0.56 (0.34–0.93)

0.04/0.03

 Adjustedb OR (95% CI)

---c

0.75 (0.42–1.36)

0.80 (0.47–1.35)

0.3/0.4

  1. CHF congestive heart failure, ESA erythropoietin-stimulating agent
  2. aAssessed in the first three sessions after index discharge
  3. bAdjusted models include patient history of congestive heart failure, index admission related to pulmonary edema, and history of non-adherence
  4. cBase outcome in multinomial logistic regression
  5. dUltrafiltration rate policy required providers to lengthen prescribed treatment time in increments of 15 min (up to 1 h) for any session in which the patient’s anticipated ultrafiltration rate (given intradialytic weight gain) was > 13 ml/kg/hour