Right TraC™ Post-Hospitalization Care Transitions Program to Reduce Readmissions for Hemodialysis Patients

American Journal of Nephrology
Rebecca L WingardFranklin W Maddux

Abstract

Hemodialysis (HD) patients have high hospitalization rates. This nonrandomized trial tested the effect of a bundle of renal-specific "Right TraC™" strategies on 30-day all-cause readmission rates and, secondarily, 90-day readmissions and overall admissions among HD patients. Twenty-six Fresenius clinics in West Virginia, Ohio, and Kentucky participated in the interventions. Eighteen matched clinics served as controls; intervention clinics also served as their own controls. We deployed the intervention in 3 incremental phases focused on patient information exchange, post-hospital follow-up, and telephonic case management. Thirty-day hospital readmissions per patient year (ppy) were calculated by dividing the total number of readmissions within 30 days of index admission by the total number of patient-years in baseline (2012) and remeasurement (2014) periods. We also compared readmission rates from 2010 to 2015. We used repeated measures Poisson regression to compare outcomes between groups and time periods. From 2012 to 2014, 30-day all-cause readmissions ppy declined for Right TraC clinics (from 0.88 to 0.66 [p < 0.001]; for controls, from 0.73 to 0.61 [p = 0.16]). Difference in change between groups was nonsignificant (p = 0.2...Continue Reading

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Citations

May 26, 2017·American Journal of Nephrology·Laura C Plantinga, Bernard G Jaar
May 26, 2018·Journal of the American Society of Nephrology : JASN·Magdalene M AssimonJennifer E Flythe
Oct 4, 2017·Clinical Journal of the American Society of Nephrology : CJASN·Magdalene M Assimon, Jennifer E Flythe
Jul 15, 2020·Clinical Journal of the American Society of Nephrology : CJASN·Simit Doshi, Jay B Wish

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