A pioneering healthcare model applying large-scale production concepts: Principles and performance after more than 11,000 transplants at Hospital do Rim

Pestana, José Osmar Medina

doi:10.1590/1806-9282.62.07.664

Cited by 13 publications

(14 citation statements)

References 7 publications

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“…The posttransplant outpatient clinic (13 offices and one emergency room) has a multidisciplinary team of nephrologists (n = 40), nurses (n = 6), pharmacists (n = 1), psychologist (n = 1), and social workers (n = 2) who see over 300 patients per day. Each patient has their own physician supervised by 3 senior nephrologists who monitor adherence to transplant center‐specified guidelines for immunosuppression, comorbidities, and hospital readmission …”

Section: Methodsmentioning

confidence: 99%

“…In Brazil, around 5000 kidney transplants are performed every year and over 90% under the government funded Unified Health Care System. The national transplant program and the population at risk have several differences compared to those seen in United States and Europe, including a unique HLA compatibility‐based allocation system turning waiting time unpredictable, regional disparities in health access, poor socioeconomic, and nutritional conditions, all interfering with transplant outcomes .…”

Section: Introductionmentioning

confidence: 99%

“…The national transplant program and the population at risk have several differences compared to those seen in United States and Europe, including a unique HLA compatibility‐based allocation system turning waiting time unpredictable, regional disparities in health access, poor socioeconomic, and nutritional conditions, all interfering with transplant outcomes . Duration of index hospitalization is longer as patients are discharged after recovered of delayed graft function (DGF) and removal of all catheters and even simple complications such as urinary tract infections requires hospital readmission as hospital day and home care treatments are not universally available and/or affordable . Considering these unique demographic and health care characteristics, it is clearly relevant to investigate the incidence, risk factor, and impact of early readmission within 30 days after discharge from kidney transplantation on mortality and graft loss within the first year.…”

Section: Introductionmentioning

confidence: 99%

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Early hospital readmission after kidney transplantation under a public health care system

Tavares

Cristelli

Paula

et al. 2019

Clinical Transplantation

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Early hospital readmission (EHR) is associated with increased mortality after kidneytransplantation. This is influenced by population demographics and the comprehensiveness of the healthcare system. We investigated the incidence and risk factors associated with EHR and 1-year patient and graft survivals. Methods:We included all recipients of kidney transplant between 2011 and 2012.We excluded recipients younger than 18 years, retransplants and who died or lost the graft during the index hospital admission.Results: Among 1175 recipients, the incidence of EHR was 26.6%. The main reasons for EHR were infection (67%), surgical complications (14%), and metabolic disturbances (11%). Independent risk factors associated with EHR were recipient age (OR = 1.95, 95% CI 1.46-2.63, P < 0.001), CMV serology negative (OR = 2.2, 95% CI 1.31-3.65, P = 0.003), use of rabbit anti-thymocyte globulin (OR = 2.06, 95% CI 1.33-3.13, P < 0.001), treatment for acute rejection during index hospitalization (OR = 1.68, 95% CI 1.15-2.47, P = 0.008), and length of stay (OR = 1.72, 95% CI 1.18-2.5, P = 0.005). Patient (88.8% vs 97.6%, P < 0.001) and death-censored graft (97.4% vs 99.0%, P < 0.001) survivals were inferior comparing patients with and without EHR.Conclusion: EHR was independently associated with mortality (OR 4.01, 95% CI 2.13-7.54, P < 0.001), but its incidence and causes are directly related to the local characteristics of the population and healthcare system. K E Y W O R D S early readmission, kidney transplantation, mortality, prognosis S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Tavares MG, Cristelli MP, Ivani de Paula M, et al. Early hospital readmission after kidney transplantation under a public health care system. Clin

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early hospital readmission after kidney transplantation under a public health care system

Tavares

Cristelli

Paula

et al. 2019

Clinical Transplantation

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“…On the other hand, it increases the risk of infections, medication errors, and accidents. 44 The main reasons for EHR were infections, surgical complications, and metabolic disturbances. Among infectious complications, CMV infection was the main cause 44 primarily because no CMV prophylaxis was used 45,46 , which contrasts with other international centers, where the main cause of readmission is surgical.…”

Section: Ehr Of Kidney Transplants Recipients In Brazilmentioning

confidence: 99%

“…44 The main reasons for EHR were infections, surgical complications, and metabolic disturbances. Among infectious complications, CMV infection was the main cause 44 primarily because no CMV prophylaxis was used 45,46 , which contrasts with other international centers, where the main cause of readmission is surgical. EHR was an independent risk factor for death in the first year and was associated with an lower patient and graft survivals at 12 months.…”

Section: Ehr Of Kidney Transplants Recipients In Brazilmentioning

confidence: 99%

Early Hospital Readmission (EHR) in kidney transplantation: a review article

2020

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Early hospital readmission (EHR), defined as all readmissions within 30 days of initial hospital discharge, is a health care quality measure. It is influenced by the demographic characteristics of the population at risk, the multidisciplinary approach for hospital discharge, the access, coverage, and comprehensiveness of the health care system, and reimbursement policies. EHR is associated with higher morbidity, mortality, and increased health care costs. Monitoring EHR enables the identification of hospital and outpatient healthcare weaknesses and the implementation of corrective interventions. Among kidney transplant recipients in the USA, EHR ranges between 18 and 47%, and is associated with one-year increased mortality and graft loss. One study in Brazil showed an incidence of 19.8% of EHR. The main causes of readmission were infections and surgical and metabolic complications. Strategies to reduce early hospital readmission are therefore essential and should consider the local factors, including socio-economic conditions, epidemiology and endemic diseases, and mobility.

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