Key result
Introduction of the DialysisConnect platform was not associated with reduced 30-day hospital readmissions (absolute difference 1.8%; 95% CI -3.7% to 7.3%; P=0.83).
Why the study?
Suboptimal care coordination between dialysis facilities and hospitals is an important driver of 30-day hospital readmissions among patients receiving dialysis.
Does a web-based provider communications platform reduce 30-day hospital readmissions in patients receiving dialysis?
Observational (n=2,419)
Yes
Does a web-based provider communications platform reduce 30-day hospital readmissions in patients receiving dialysis?
The introduction of a web-based provider communications platform between a hospital and dialysis facilities did not significantly reduce 30-day hospital readmissions.
Web-based platform was not associated with reduced readmissions; leaves open efficacy of care-transition tools in dialysis pending randomized trials.
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). 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.
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Plantinga et al. (2022) conducted an observational in Patients receiving dialysis (n=2,419). Web-based communications platform (DialysisConnect) vs. Prepilot period and control facilities was evaluated on 30-day readmission (absolute difference 1.8%, 95% CI -3.7 to 7.3, p=0.83). Introduction of the DialysisConnect platform was not associated with reduced 30-day hospital readmissions (absolute difference 1.8%; 95% CI -3.7% to 7.3%; P=0.83).
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