Risk factors for hospitalization in well-dialyzed chronic hemodialysis patients

Background/Aims: Hemodialysis (HD) patients are hospitalized more frequentl y than patients with other chronic diseases, averaging 11.5 hospital days/p atient/year. Hospital costs attributable to renal failure in the US exceed $2 billion per year. The present healthcare climate continues to force dial ysis providers to focus on these issues in order to optimize patient care w hile limiting cost. Methods: We used a novel method for analyzing hospitali zation risk, a multiple-event Cox proportional hazards model, to identify f actors that influenced hospitalization in a HD unit population over a two-y ear period. This model allows individual patients to contribute multiple fa ilure events to the model while controlling for the serial dependency of ev ents. Results: 178 HD patients were retrospectively examined. There were 38 1 hospitalizations during the study period, averaging out to 1.9 hospitaliz ations and 10.5 hospital days/patient-year. Substance abuse and diabetes co nveyed the largest risks for hospitalization (diabetes RR: 2.09; substance abuse RR: 2.24) in the study cohort, exposing the necessity for examining p ractice patterns and behavioral interventions as means for improving HD pat ient care. Conclusion: Despite the small numbers of patients in this single -center HD population, the model achieved adequate statistical power. There fore, it has the potential to serve as a continuous quality improvement (CQ I) tool in particular HD patient sub-groups, or in individual HD units. Cop yright (C) 1999 S. Karger AG. Basel.