Effectiveness of a Web-Based Provider Communications Platform in Reducing Hospital Readmissions Among Patients Receiving Dialysis: A Pilot Pre-Post Study

Laura C Plantinga; Anjali Khakharia; Courtney Hoge; Ann E Vandenberg; Janice P Lea; Tahsin Masud; Carol Gray; Christopher M O'Donnell; Kyle James; Rich Mutell; Bernard G Jaar

doi:10.1016/j.xkme.2022.100511

Effectiveness of a Web-Based Provider Communications Platform in Reducing Hospital Readmissions Among Patients Receiving Dialysis: A Pilot Pre-Post Study

Kidney Med. 2022 Jun 26;4(8):100511. doi: 10.1016/j.xkme.2022.100511. eCollection 2022 Aug.

Authors

Affiliations

¹ Department of Medicine, Emory University School of Medicine, Atlanta, GA.
² Emory Healthcare, Atlanta, GA.
³ Apex Health Innovations, Williamsburg, VA.
⁴ Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
⁶ Nephrology Center of Maryland, Baltimore, MD.
⁷ Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.

Abstract

Rationale & objective: Suboptimal care coordination between dialysis facilities and hospitals is an important driver of 30-day hospital readmissions among patients receiving dialysis. We examined whether the introduction of web-based communications platform ("DialysisConnect") was associated with reduced hospital readmissions.

Study design: Pilot pre-post study.

Setting & participants: A total of 4,994 index admissions at a single hospital (representing 2,419 patients receiving dialysis) during the study period (January 1, 2019-May 31, 2021).

Intervention: DialysisConnect was available to providers at the hospital and 4 affiliated dialysis facilities (=intervention facilities) during the pilot period (November 1, 2020-May 31, 2021).

Outcomes: The primary outcome was 30-day readmission; secondary outcomes included 30-day emergency department visits and observation stays. Interrupted time series and linear models with generalized estimating equations were used to assess pilot versus prepilot differences in outcomes; difference-in-difference analyses were performed to compare these differences between intervention versus control facilities. Sensitivity analyses included a third, prepilot/COVID-19 period (March 1, 2020-October 31, 2020).

Results: There was no statistically significant difference in the monthly trends in the 30-day readmissions pilot versus prepilot periods (-0.60 vs -0.13, P = 0.85) for intervention facility admissions; the difference-in-difference estimate was also not statistically significant (0.54 percentage points, P = 0.83). Similar analyses including the prepilot/COVID-19 period showed that, despite a substantial drop in admissions at the start of the pandemic, there were no statistically significant differences across the 3 periods. The age-, sex-, race-, and comorbid condition-adjusted, absolute pilot versus prepilot difference in readmissions rate was 1.8% (-3.7% to 7.3%); similar results were found for other outcomes.

Limitations: Potential loss to follow-up and pandemic effects.

Conclusions: In this pilot, the introduction of DialysisConnect was not associated with reduced hospital readmissions. Tailored care coordination solutions should be further explored in future, multisite studies to improve the communications gap between dialysis facilities and hospitals.

Keywords: Care coordination; dialysis; end-stage renal disease; hospital readmission; intervention; provider communication.