Hospital utilization among chronic dialysis patients

Factors driving inpatient and outpatient utilization were studied among pat ients who began dialysis for chronic renal failure at the New England Medic al Center (NEMC) between 1992 and 1997. Clinical, laboratory, and hospital resource utilization data were obtained from patient records and electronic databases. There were 2.2 hospitalizations and 14.8 hospital days per pati ent year at risk (PYAR). The number of hospitalizations and hospital days p er PYAR were higher in the first 3 mo of initiating dialysis (4.3 and 28.3, respectively) compared to after 3 mo (1.9 and 12.9, respectively). Factors associated with increased risk of hospital days within the first 3 mo incl uded non-health maintenance organization insurance, ischemic heart disease, late referral to the nephrologist, and use of temporary vascular access fo r the first dialysis. Patients with ischemic heart disease and who received dialysis during the years 1992-1994 compared with 1996-1997 had an increas ed risk of hospital days after 3 mo of initiating dialysis. There were 16.6 outpatient visits per PYAR, with significant differences in utilization be tween the first 3 mo and after 3 mo of initiating dialysis. Thus, hospital utilization was significantly higher in the first 3 mo compared to after 3 mo, and factors associated with hospital utilization depended on duration o f dialysis. In particular, delayed referral to the nephrologist and lack of permanent vascular access were independently associated with increased ris k of hospital utilization in the first 3 mo of dialysis. Greater attention to timely referral to the nephrologist and timely placement of vascular acc ess could result in reduced utilization and cost savings.