The morbidity and cost implications of hemodialysis clinical performance measures
| Autor: | Andrew S. O’Connor, Jay B. Wish, Ashwini R. Sehgal |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
Quality management Fistula medicine.medical_treatment Disease Medicare Renal Dialysis Health care medicine Humans Intensive care medicine Reimbursement Dialysis Quality of Health Care Inpatients business.industry Hematology medicine.disease United States Confidence interval Hospitalization Nephrology Costs and Cost Analysis Hemodialysis Morbidity business |
| Zdroj: | Hemodialysis International. 9:349-361 |
| ISSN: | 1542-4758 1492-7535 |
| DOI: | 10.1111/j.1542-4758.2005.01153.x |
| Popis: | Clinical performance measures, including dialysis dose, hemoglobin, albumin, and vascular access, are the focus of monitoring and quality improvement activities. However, little is known about the implications of clinical performance measures for hospital utilization and health care costs. We obtained clinical performance measures and hospitalization records for a national random sample of 10,650 hemodialysis patients and analyzed the relationship between changes in clinical performance measures and hospital utilization after adjustment for patient demographic and medical characteristics. Higher hemoglobin, higher albumin, and fistula or graft use were independently associated with fewer hospitalizations, fewer hospital days, and decreased Medicare inpatient reimbursement. For example, a 0.5 g/dL higher hemoglobin, a 0.25 g/dL higher albumin, fistula use, and graft use were associated with hospitalization rate ratios of 0.90 (95% confidence interval 0.85, 0.96), 0.64 (0.53, 0.77), 0.60 (0.52, 0.69), and 0.79 (0.71, 0.89), respectively. Moreover, there was a 2–3-fold variation in hospital utilization across end-stage renal disease networks that was still evident after adjustment for patient characteristics and clinical performance measures. Clinical performance measures, especially albumin and vascular access, are strongly associated with hospital utilization and health care costs. These results highlight the importance of targeting nutrition and vascular access in quality improvement efforts. The marked variation in hospital utilization across networks deserves further examination. |
| Databáze: | OpenAIRE |
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