An investigation of treatment barriers for End-Stage Kidney Disease patients using advanced analytics

This study uses advanced analytics to investigate the treatment barriers faced by unfunded patients suffering from end-stage kidney disease at Parkland Hospital. Under the Emergency Medical Treatment and Labor Act (EMTALA) federal law, these patients can receive dialysis only under emergency conditions. This practice, commonly known as “emergent dialysis,” routes patients through the Emergency Room (ER) for a screening assessment to determine whether they will be accepted for treatment. Utilizing a data set from Parkland Hospital on patient ER visits seeking emergent dialysis, we leverage descriptive analytics and statistical methods to investigate (i) the impact of this accept/reject decision process on patient outcomes and (ii) the potential influence of operational, medical, and behavioral factors, such as the ER load, patient acuity level, and accept/reject patient history on it. Our research highlights an unanticipated burden caused by a subset of occasional dialysis patients with notably infrequent visits—the aspect that should not be overlooked. It also pinpoints discrepancies across patients, e.g., counterintuitively, patients accepted for treatment experienced shorter wait times before the decision was made than those rejected. More importantly, our work reveals that operational and behavioral factors influence the decision-making process substantially, much more than medical ones. The above findings underscore the critical role of analytics in our model. Our work further employs prescriptive analytics and simulation optimization approaches to provide recommendations on how policymakers can leverage the insights above to make more effective decisions that improve care delivery for this vulnerable population.