Utilization of Acute Care among Patients with ESRD Discharged Home from Skilled Nursing Facilities

Hall, Rasheeda K.; Toles, Mark; Massing, Mark W.; Jackson, E. Atlee; Peacock-Hinton, Sharon; O’Hare, Ann M.; Colón‐Emeric, Cathleen

doi:10.2215/cjn.03510414

Cited by 25 publications

(24 citation statements)

References 27 publications

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“…It is important to also categorize patients currently in skilled nursing facilities (SNF) or those recently discharged from them, as particularly high risk for hospitalizations. Patients residing in SNFs have been repeatedly shown to have much higher hospitalization rates than non‐SNF patients on hemodialysis, the reasons for which are beyond the scope of this paper . Transitions from SNF to home had a higher rate of rehospitalizations (42% vs 35% in noninstitutionalized patients) and shorter SNF stays associated with increased short ED visits …”

Section: Strategies To Mitigate Future Hospitalization In Patients Onmentioning

confidence: 93%

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Golestaneh

2018

Seminars in Dialysis

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Hospitalizations drive up to 35% of the astronomical costs of care for patients on hemodialysis and are associated with poor outcomes. We describe outpatient care-sensitive categories of hospitalization risks in an effort to engage stakeholders and patients, as stakeholders, in mitigating hospitalizations. These categories include: (1) fluid (interdialytic weight gain (IDWG) and chronic volume status), (2) infection (vascular access and malnutrition/inflammation resilience), and c) psychosocial (poor social support, poor self-efficacy, and mood disorders) risks. Barriers to improving hospitalization outcomes, especially as they relate to above risk categories, exist at multiple stakeholder levels and include: (1) dialysis facilities (strict shift changes, personnel challenges), (2) nephrologists (static dialysis prescriptions and protocols based on dialysis facility metrics), and (3) patients (lack of engagement and self-efficacy). System-level elements, such as payment models, help to propagate these barriers. In this article, we seek to shift the care paradigm discussion to patient trajectories and long-term outcomes, and to active engagement of patients as self-managers, through which we hope to impact on high inpatient resource utilization. We will also focus attention on the complex interplay of practices that have become acceptable care structures, but that may be deleterious to outcomes. Only after thorough consideration of these topics can we hope to impact on this important problem.

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Section: Strategies To Mitigate Future Hospitalization In Patients Onmentioning

confidence: 93%

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Golestaneh

2018

Seminars in Dialysis

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“…7 Studies have also reported that CVD contributes significantly to morbidity among ESRD patients, leading to frequent hospitalizations and re-hospitalizations. 8–10 Presence of CVD also adversely affects long-term survival in ESRD patients. CVD contributes to more than half of all deaths in patients with ESRD (Figure 1).…”

Section: Epidemiology Of Cardiovascular Disease At End-stage Renal DImentioning

confidence: 99%

Evolution of Cardiovascular Disease During the Transition to End-Stage Renal Disease

Bansal

2017

Seminars in Nephrology

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Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD). The rate of death in incident dialysis patients remains high. This has led to interest in the study of the evolution of CVD during the critical transition period from CKD to ESRD. Understanding the natural history and risk factors of clinical and subclinical CVD during this transition may help guide the timing of appropriate CVD therapies to improve outcomes in patients with kidney disease. This review will provide an overview of the epidemiology of subclinical and clinical CVD during the transition from CKD to ESRD and discuss clinical trials of CVD therapies to mitigate risk of CVD in CKD and ESRD patients.

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“…In this issue of CJASN, Hall et al examine hospital admissions and emergency room (ER) visits among patients with ESRD after discharge from SNFs in 2010 and 2011 (13). They use data from Nursing Home Compare, a registry of Medicare and Medicaid certified nursing homes, along with Medicare claims to identify a cohort of patients with ESRD and Medicare, aged $65 years, living in North and South Carolina.…”

mentioning

confidence: 99%

“…Finally, it will be important to study whether use of home health services can prevent hospitalizations in certain cases. In particular, the findings from the study by Hall et al (13) suggest that efforts directed toward managing wounds may be fruitful.…”

mentioning

confidence: 99%

“…Increasing evidence from different health care settings and across chronic diseases suggests that care coordination during care transitions can improve both health outcomes and quality of life, and may reduce health care costs (6). The study by Hall et al (13) identifies an important and overlooked health care transition in patients with ESRD-the one occurring after SNF discharge. Researchers and policymakers must now identify the essential ingredients of transitional care and determine how best to integrate transitional care with dialysis care.…”

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confidence: 99%

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Overlooked Care Transitions

Erickson

Tamura

2015

Clinical Journal of the American Society of Nephrology

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Utilization of Acute Care among Patients with ESRD Discharged Home from Skilled Nursing Facilities

Abstract: Background and objectives Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about acute care use after SNF discharge to home.

Cited by 25 publications

References 27 publications

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

Evolution of Cardiovascular Disease During the Transition to End-Stage Renal Disease

Overlooked Care Transitions

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