Causation and Confounding Factors for 30-Day Readmission of Kidney Transplant Patients: A Descriptive Study

2.50
Hdl Handle:
http://hdl.handle.net/10755/621929
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Causation and Confounding Factors for 30-Day Readmission of Kidney Transplant Patients: A Descriptive Study
Other Titles:
Health Promotion for Patients with Kidney Disease
Author(s):
Dols, Jean Dowling; Chargualaf, Katie A.
Lead Author STTI Affiliation:
Beta Beta (Houston)
Author Details:
Jean Dowling Dols, PhD, RN, NEA-BC, FACHE, Professional Experience: Dr Dols has more than 25 years experience as a healthcare executive and transformational leader in nursing, quality, community health, research, and informatics. Currently an Associate Professor at the University of the Incarnate Word, Dr. Dols works with a transplant & specialty hospital in an academic-practice partnership that has driven the implementation of evidence-based practice, practice redesign, and research. Dr. Dols has presented extensively nationally and internationally and has published more than 15 professional publications. Author Summary: Dr Dols has more than 25 years experience as a healthcare executive and transformational leader in nursing, quality, community health, research, and informatics. Currently an Associate Professor at the University of the Incarnate Word, Dr. Dols has presented extensively nationally and internationally and has published more than 15 professional publications. A partner in an academic-practice partnership Dr Dols is leading the implementation of research in the transplant population.
Abstract:

According to a recent study analyzing six years of national kidney transplant data, 31% of patients hospitalized for a kidney transplant required hospital readmission within 30 days of discharge (6). This study analyzed data of 32,000 patients for the years 2000-2005 finding 30-day kidney transplant readmission varying by facility from 18% to 51% (6). Some of the risk factors associated with early hospital readmission included age, race, body mass index (BMI), diabetes, heart disease, and length of stay (6). Additional studies identified level of education (8), time on dialysis (2), donor type (3,4), and a lack of understanding of post-transplant medications (2) as significant risk factors contributing to early readmissions. Specific populations found to have a higher rate of readmission include African Americans (11% higher), obese patients (15% higher), and diabetic women (29% higher) (6). Indications for readmission to the hospital are varied. More commonly reported causes include infection (1,2,3,4,5), surgical complications (1,2,3,4,5), and acute rejection (3,4).

The Centers for Medicare and Medicaid Services use readmissions as a proxy measure of hospital quality. While there are an expected number of 30-day readmissions, CMS currently tracks hospital readmissions and reduces Inpatient Prospective Payment System (IPPS) payments for specific conditions, but doesn’t currently include transplants in these payment reductions (7). Re-hospitalization increases the cost of care for patients, providers, and payers. It often reflects incidents that may have been preventable and have the potential to increase patient mortality.

The researchers responsible for the national study of kidney transplant data emphasize that better outpatient management systems may reduce the number of rehospitalizations (6). However, the researchers of this study are unsure if that solution is the appropriate one for the kidney transplant population served by our hospital and others in the southern region of the U.S. with a high diversity factor, extensive travel to receive an organ, and the incredibly rapid growth of the kidney transplant population.

Identifying the risk factors and causes for kidney transplant 30-day readmission may enable healthcare facilities to structure care processes to reduce the influence of this population’s particular risk factors and the causes of readmission. As readmission may reflect opportunities to improve inpatient care, care transition to another care setting, and outpatient care, a comprehensive analysis of the factors that may place patients at risk and the causes for readmission is essential to assure appropriate selection and effective implementation of interventions to reduce readmissions.

The purpose of this study is to identify the risk factors, causes, and confounding factors for 30-day readmissions in kidney transplant patients in the Southern region of the United States.

Methods:

A descriptive, retrospective study was undertaken. The medical records of patients 18 years of age and older hospitalized in a southern region transplant center for kidney transplant surgery December 2015 to June 2016 who were re-admitted to the hospital within 30 days were analyzed. Each patient's hospital and clinic records were reviewed for readmission causes and risk factors identified through the literature and experience of experts in the care of kidney transplant patients and their readmissions using a data collection tool developed by the researchers. Data was analyzed using IBM® SPSS ® Version 21.

Results:

Findings at the Southern U.S. Region transplant center were uniquely different from the U.S. in the areas of risk factors and causes of readmission. The transplant center has experienced a rapid escalation of kidney transplants increasing over the last 10 years from 152 (62 deceased donor transplants/90 live donor transplants) in 2006 to 313 (140 deceased donor transplants/173 live donor transplants) in 2015. Unlike the predominant U.S. kidney transplant patients who are white, male, and the recipient of a deceased donor transplant; the patients receiving transplants at this regional transplant center are Hispanic, female, and the recipient of a living donor transplant.

Patients in the study were more likely to be readmitted if they were a recipient of a deceased donor transplant in comparison to the recipient of a live donor transplant, as is the U.S. population of kidney transplant patients. Also similar to the U.S. population, the kidney transplant patients in the study experienced higher 30-day readmissions if they had a deceased donor transplant with a prior history of diabetes mellitus.

Differences in the study population from the U.S. transplant population were that patients 50+ years old were more likely to be readmitted than any other age group whether they were the recipient of a living or deceased donor. Education less than college was associated with increased readmission, as were body mass index 26+, prior history of diabetes mellitus, being a woman, and being Hispanic. 30-day readmissions were more likely to occur within 14 days of discharge. Patients at the transplant center traveled up to 339 miles to receive their transplant and readmission was more likely if the patient traveled more than 20 miles from their home to the hospital.

The cause of readmission reported in the literature varies widely. To improve consistency and allow for comparisons, the causes for the readmissions in this study were grouped into previously reported categories (1,2,3,4,5). Similar to readmission causes for U.S. kidney transplant patients, the most common etiologies included allograft dysfunction (including rejection and Acute Kidney Injury) (46%), infection (18%), and surgical complications (13%). Yet 30-day readmissions for the transplant center were higher than the U.S. kidney transplant population in the areas of symptom management and fluid/electrolyte imbalances related to post-transplant including nausea and vomiting (18%), volume overload/depletion (15%), electrolyte imbalances (13%), and cardiovascular events (hypotension/hypertension) (10%).

Conclusion:

Risk factors for 30-day readmission in this sample of patients in the Southern region are significantly different than the U.S. population, as are the characteristics of the Southern population. The causes for 30-day readmission in this Southern U.S. sample also are different in the areas of post-transplant symptom management and fluid/electrolyte imbalance. The results of this study are informing future research studies and intervention plans aimed at reducing the readmissions of kidney transplant patients unique to this region. Recommendations for study include investigation of the clarity of communication and education for Spanish-speaking patients, patients with a lower level of education, and patients by age group. In relation to the causes for readmission, additional understanding and potential interventions are needed regarding the transplant patient’s medication knowledge and adherence and their methods of seeking healthcare assistance post-transplant for symptom management and fluid/electrolyte imbalance. Future studies planned include interventional studies that will impact transplant patient readmissions for women, patients who have a Body Mass Index greater than 25, and patients with a prior history of Diabetes Mellitus Type II.

Keywords:
30-day readmission causes; kidney transplant; risk factors
Repository Posting Date:
19-Jul-2017
Date of Publication:
19-Jul-2017
Other Identifiers:
INRC17I08
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleCausation and Confounding Factors for 30-Day Readmission of Kidney Transplant Patients: A Descriptive Studyen_US
dc.title.alternativeHealth Promotion for Patients with Kidney Diseaseen
dc.contributor.authorDols, Jean Dowlingen
dc.contributor.authorChargualaf, Katie A.en
dc.contributor.departmentBeta Beta (Houston)en
dc.author.detailsJean Dowling Dols, PhD, RN, NEA-BC, FACHE, Professional Experience: Dr Dols has more than 25 years experience as a healthcare executive and transformational leader in nursing, quality, community health, research, and informatics. Currently an Associate Professor at the University of the Incarnate Word, Dr. Dols works with a transplant & specialty hospital in an academic-practice partnership that has driven the implementation of evidence-based practice, practice redesign, and research. Dr. Dols has presented extensively nationally and internationally and has published more than 15 professional publications. Author Summary: Dr Dols has more than 25 years experience as a healthcare executive and transformational leader in nursing, quality, community health, research, and informatics. Currently an Associate Professor at the University of the Incarnate Word, Dr. Dols has presented extensively nationally and internationally and has published more than 15 professional publications. A partner in an academic-practice partnership Dr Dols is leading the implementation of research in the transplant population.en
dc.identifier.urihttp://hdl.handle.net/10755/621929-
dc.description.abstract<p>According to a recent study analyzing six years of national kidney transplant data, 31% of patients hospitalized for a kidney transplant required hospital readmission within 30 days of discharge (6). This study analyzed data of 32,000 patients for the years 2000-2005 finding 30-day kidney transplant readmission varying by facility from 18% to 51% (6). Some of the risk factors associated with early hospital readmission included age, race, body mass index (BMI), diabetes, heart disease, and length of stay (6). Additional studies identified level of education (8), time on dialysis (2), donor type (3,4), and a lack of understanding of post-transplant medications (2) as significant risk factors contributing to early readmissions. Specific populations found to have a higher rate of readmission include African Americans (11% higher), obese patients (15% higher), and diabetic women (29% higher) (6). Indications for readmission to the hospital are varied. More commonly reported causes include infection (1,2,3,4,5), surgical complications (1,2,3,4,5), and acute rejection (3,4).</p> <p>The Centers for Medicare and Medicaid Services use readmissions as a proxy measure of hospital quality. While there are an expected number of 30-day readmissions, CMS currently tracks hospital readmissions and reduces Inpatient Prospective Payment System (IPPS) payments for specific conditions, but doesn’t currently include transplants in these payment reductions (7). Re-hospitalization increases the cost of care for patients, providers, and payers. It often reflects incidents that may have been preventable and have the potential to increase patient mortality.</p> <p>The researchers responsible for the national study of kidney transplant data emphasize that better outpatient management systems may reduce the number of rehospitalizations (6). However, the researchers of this study are unsure if that solution is the appropriate one for the kidney transplant population served by our hospital and others in the southern region of the U.S. with a high diversity factor, extensive travel to receive an organ, and the incredibly rapid growth of the kidney transplant population.</p> <p>Identifying the risk factors and causes for kidney transplant 30-day readmission may enable healthcare facilities to structure care processes to reduce the influence of this population’s particular risk factors and the causes of readmission. As readmission may reflect opportunities to improve inpatient care, care transition to another care setting, and outpatient care, a comprehensive analysis of the factors that may place patients at risk and the causes for readmission is essential to assure appropriate selection and effective implementation of interventions to reduce readmissions.</p> <p>The purpose of this study is to identify the risk factors, causes, and confounding factors for 30-day readmissions in kidney transplant patients in the Southern region of the United States.</p> <p><strong>Methods:</strong></p> <p>A descriptive, retrospective study was undertaken. The medical records of patients 18 years of age and older hospitalized in a southern region transplant center for kidney transplant surgery December 2015 to June 2016 who were re-admitted to the hospital within 30 days were analyzed. Each patient's hospital and clinic records were reviewed for readmission causes and risk factors identified through the literature and experience of experts in the care of kidney transplant patients and their readmissions using a data collection tool developed by the researchers. Data was analyzed using IBM® SPSS ® Version 21.</p> <p><strong>Results:</strong></p> <p>Findings at the Southern U.S. Region transplant center were uniquely different from the U.S. in the areas of risk factors and causes of readmission. The transplant center has experienced a rapid escalation of kidney transplants increasing over the last 10 years from 152 (62 deceased donor transplants/90 live donor transplants) in 2006 to 313 (140 deceased donor transplants/173 live donor transplants) in 2015. Unlike the predominant U.S. kidney transplant patients who are white, male, and the recipient of a deceased donor transplant; the patients receiving transplants at this regional transplant center are Hispanic, female, and the recipient of a living donor transplant.</p> <p>Patients in the study were more likely to be readmitted if they were a recipient of a deceased donor transplant in comparison to the recipient of a live donor transplant, as is the U.S. population of kidney transplant patients. Also similar to the U.S. population, the kidney transplant patients in the study experienced higher 30-day readmissions if they had a deceased donor transplant with a prior history of diabetes mellitus.</p> <p>Differences in the study population from the U.S. transplant population were that patients 50+ years old were more likely to be readmitted than any other age group whether they were the recipient of a living or deceased donor. Education less than college was associated with increased readmission, as were body mass index 26+, prior history of diabetes mellitus, being a woman, and being Hispanic. 30-day readmissions were more likely to occur within 14 days of discharge. Patients at the transplant center traveled up to 339 miles to receive their transplant and readmission was more likely if the patient traveled more than 20 miles from their home to the hospital.</p> <p>The cause of readmission reported in the literature varies widely. To improve consistency and allow for comparisons, the causes for the readmissions in this study were grouped into previously reported categories (1,2,3,4,5). Similar to readmission causes for U.S. kidney transplant patients, the most common etiologies included allograft dysfunction (including rejection and Acute Kidney Injury) (46%), infection (18%), and surgical complications (13%). Yet 30-day readmissions for the transplant center were higher than the U.S. kidney transplant population in the areas of symptom management and fluid/electrolyte imbalances related to post-transplant including nausea and vomiting (18%), volume overload/depletion (15%), electrolyte imbalances (13%), and cardiovascular events (hypotension/hypertension) (10%).</p> <p><strong>Conclusion:</strong></p> <p>Risk factors for 30-day readmission in this sample of patients in the Southern region are significantly different than the U.S. population, as are the characteristics of the Southern population. The causes for 30-day readmission in this Southern U.S. sample also are different in the areas of post-transplant symptom management and fluid/electrolyte imbalance. The results of this study are informing future research studies and intervention plans aimed at reducing the readmissions of kidney transplant patients unique to this region. Recommendations for study include investigation of the clarity of communication and education for Spanish-speaking patients, patients with a lower level of education, and patients by age group. In relation to the causes for readmission, additional understanding and potential interventions are needed regarding the transplant patient’s medication knowledge and adherence and their methods of seeking healthcare assistance post-transplant for symptom management and fluid/electrolyte imbalance. Future studies planned include interventional studies that will impact transplant patient readmissions for women, patients who have a Body Mass Index greater than 25, and patients with a prior history of Diabetes Mellitus Type II.</p>en
dc.subject30-day readmission causesen
dc.subjectkidney transplanten
dc.subjectrisk factorsen
dc.date.available2017-07-19T14:57:01Z-
dc.date.issued2017-07-19-
dc.date.accessioned2017-07-19T14:57:01Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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