3 years ago

Emergency Department Utilization among Kidney Transplant Recipients in the United States

Jason M. Hockenberry, Christian P. Larsen, Rebecca Zhang, Brendan P. Lovasik, Sumit Mohan, Stephen O. Pastan, Justin D. Schrager, Rachel E. Patzer, Andrew B. Adams
Patients with End Stage Renal Disease (ESRD) use the emergency department (ED) at a 6-fold higher rate than U.S. adults. No national studies have described ED utilization rates among kidney transplant (KTx) recipients, and the factors associated with higher ED utilization. We examined a cohort of 132,725 adult KTx recipients in the United States Renal Data System (2005-2013). ED visits, hospitalization, and outpatient nephrology visits were obtained from Medicare claims databases. Nearly half (46.1%) of KTx recipients had at least one ED visit (1.61 ED visits/patient year) and 39.7% of ED visits resulted in hospitalization in the first year post-transplant. ED visit rate was high in the first 30 days (5.26 visits/person year (PY)), but declined substantially thereafter (1.81 visits/ PY in months 1-3; 1.13 visits/PY in months 3-12 post-transplant). ED visit rates were higher in the first 30 days vs. dialysis patients, but less than half the rate thereafter. Female sex, public insurance, medical comorbidities, longer pre-transplant dialysis vintage, and delayed graft function were associated with higher ED utilization in the first year post-KTx. Policies and strategies addressing potentially preventable ED visits should be promoted to help improve patient care and increase efficient utilization of ED resources. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14578

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