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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