ESRD re-admissions are a major concern. A recent KI paper discusses what the nephrology literature has found regarding this very important issue. Unfortunately, no studies have tested interventions in how to avoid re-admissions for our dialysis patients. The authors propose certain areas for research.
An interesting concept that is discussed in table 3 of the paper is the potential places where the factors might be of the risk and how we can target our research in those 5 areas.
1. The patient related risk factors ( socio-demographics, social support .etc)
2. Index hospitalization( the first hospitalization and how to void re-admissions related to that admission, med reconciliation, structured communication from inpatient to outpatient units)
3. Nephrologist ( timing of first visit post discharge, extra weekly visit for the hospitalized patient, effect of targeted structured eval only addressing certain key variables such as dry weight, access, medications changes)
4. Dialysis unit- coordination with inpatient dialysis unit and ER of the hospital
5. Payment structure- effect of resource redistribution in different payer models