DOI
https://doi.org/10.25772/3ZMB-0408
Author ORCID Identifier
https://orcid.org/0000-0002-3011-3669
Defense Date
2019
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Nursing
First Advisor
Marianne Baernholdt, PhD, MPH, RN, FAAN
Second Advisor
Tamara Kear, PhD, RN, CNS, CNN
Third Advisor
Leroy R. Thacker II, Ph.D.
Fourth Advisor
Terry L. Jones PhD, RN
Abstract
Hospital readmissions are a major burden for patients with end stage renal disease (ESRD). On average, one in three hospital discharges among patients with ESRD are followed by a readmission within 30 days. Currently, dialysis facilities are held accountable for readmissions via the ESRD Quality Incentive Program standardized readmission ratio (SRR) clinical measure. However, little is known about facility-level factors associated with readmission. Additionally, unlike other standardized measures of quality in the dialysis setting, incident patients within their first 90-days of dialysis are included in the performance calculation. This study analyzed CMS Dialysis Facility Report data from 2013 to 2016 to examine dialysis facility and incident patient factors associated with SRR using multivariate mixed models. Among 5,419 dialysis facilities treating 104,768 incident patients, the mean SRR remained stable across all four study years at 0.99. Factors significantly associated with a lower SRR (p<0.0001) included Western geographic region and higher patient care technician ratios. Several incident patient pre-dialysis nephrology care characteristics were associated with lower SRRs including higher percentages of patients with a fistula present at first dialysis treatment, higher percentages of patients receiving 6-12 months or greater than 12 months of nephrology care prior to dialysis and higher facility average hemoglobin. Factors significantly associated with a higher SRR (p<0.0001) included Northeastern geographic region, higher registered nurse ratios, higher percentage of incident patients, and higher facility average GFR. Understanding facility-level and patient-level factors associated with higher SRRs may inform interventions to reduce 30-day hospital readmission among patients receiving dialysis.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
7-10-2019
Included in
Clinical Epidemiology Commons, Health Services Research Commons, Nephrology Commons, Other Nursing Commons, Patient Safety Commons, Public Health Education and Promotion Commons