Extra Doctor Visit Cut Re-Hospitalizations of Dialysis Patients

Dialysis patients had lower repeat hospital admission rates after a single additional trip to the doctor

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Some health disorders drive up the number of costly, repeated hospitalizations and may demand more physician oversight. Kidney failure is one of those disorders.

Dialysis patients who visited the doctor an extra time within a month after being released from the hospital trimmed their rates of re-hospitalization, according to a recent study.

"If you're on dialysis, see your doctor soon after leaving the hospital."

This study’s lead author was Kevin Erickson, MD, MS, of Stanford University School of Medicine’s Center for Primary Care and Outcomes Research, in Stanford, CA.

For this research, Dr. Erickson and his team of investigators reviewed the medical records of patients who accounted for 26,613 month-long hospitalizations to treat end-stage renal disease between 2004 and 2009. Those kidney failure patients were on dialysis.

These researchers set out to determine how many patients made at least one additional visit to their doctor within a month after being hospitalized for kidney failure. Then, the researchers explored whether such visits reduced patients’ chances of being re-hospitalized within 30 days of leaving the hospital.

Based on that exploration, these researchers concluded that making one extra doctor's exam within a month after being released from the hospital yielded a 3.5 percent decrease in dialysis patients' re-admissions to the hospital within 30 days of leaving the hospital.

"Although a 3.5 percent reduction in the rate of re-hospitalization may seem modest, it could lead to large, aggregate reductions in the number of hospitalizations per year," these researchers wrote.

Of those 26,613 month-long hospital stays, 36.2 percent involved patients who ended up being re-admitted to the hospital. And 8.1 percent involved patients who died, the researchers found.

Patients who were not re-hospitalized sometimes saw their doctors more than once after being released from the hospital. Of patients who were not re-admitted, 67.4 percent visited their physicians at least four times in the month after leaving the hospital. By comparison, 32.4 percent of those who were re-hospitalized were examined by their doctors at least four times in the month after their initial hospital stay ended.

"This research is important by highlighting the role that outpatient [doctor visits] have in preventing hospital re-admissions for patients receiving hemodialysis," Dr. Erickson said in a press statement.

After the researchers sub-divided those 26,613 patient hospitalizations, they also concluded that other factors were at play. The chances of being re-admitted to the hospital within 30 days of leaving the hospital also depended on whether patients underwent dialysis at for-profit dialysis centers, lived in heavily populated cities, received Medicaid or were low-income enough to qualify for Medicaid. Decreases in re-admission rates among those four groups ranged from 0.5 percent to 4.9 percent.

Medicaid is health insurance that the federal and state governments fund for low-income people.

Medicare is insurance the federal government funds for those aged 65 and older. Based on today’s reimbursement rates for Medicare, there would be $240 million a year in Medicare savings if dialysis patients made an extra trip to their doctor within a month after being released from the hospital, these researchers wrote. That would equal 31,370 fewer hospitalizations a year of dialysis patients getting Medicare, they added.

The researchers noted that dialysis patients who were re-admitted to the hospital within 30 days were more likely to have a range of co-existing illnesses. Those conditions included liver, heart and lung disease, heart failure, high blood pressure, peptic ulcers and drug addiction.

Diabetes and high blood pressure are the leading causes of kidney failure, and obesity is a leading cause of both those disorders.

According to the latest available yearly data from the National Kidney and Urologic Diseases Information Clearinghouse, roughly 400,000 people are on dialysis.

Reducing costly hospital re-admissions has been a key component of health policy reform. More regular monitoring of patients after they leave the hospital helps to bring down those costs, the researchers wrote. Compared to the $12,634 spent on those who were re-hospitalized, those who were not re-hospitalized during the month after they left the hospital cost $3,700 to treat, the researchers wrote.

This study was published online May 8 in the Journal of the American Society of Nephrology.

The researchers did not disclose which, if any, organization funded this study.

These researchers reported that they had no financial investments or other ethical conflicts that would affect study design, outcomes and analysis.

Review Date: 
May 7, 2014
Last Updated:
May 8, 2014