Predicting and preventing readmissions in kidney transplant recipients

• Published in: Clinical transplantation Vol. 30; no. 7; pp. 779 - 786
• Main Authors: Covert, Kelly L., Fleming, James N., Staino, Carmelina, Casale, Jillian P., Boyle, Kimberly M., Pilch, Nicole A., Meadows, Holly B., Mardis, Caitlin R., McGillicuddy, John W., Nadig, Satish, Bratton, Charles F., Chavin, Kenneth D., Baliga, Prabhakar K., Taber, David J.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01-07-2016
• Subjects: Case-Control Studies; Female; Follow-Up Studies; healthcare quality; hospital readmission; Humans; Incidence; Kidney Transplantation; Length of Stay - trends; Male; Medication Adherence; Middle Aged; Patient Outcome Assessment; Patient Readmission - trends; pharmacy; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Retrospective Studies; Risk Factors; United States - epidemiology; pharmacy; healthcare quality; hospital readmission; medication adherence; kidney transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12748

A lack of research exploring post‐transplant process optimization to reduce readmissions and increasing readmission rates at our center from 2009 to 2013 led to this study, aimed at assessing the effect of patient and process factors on 30‐d readmission rates after kidney transplantation.
This was a retrospective case–control study in adult kidney transplant recipients. Univariate and multivariate analyses were utilized to assess patient and process determinants of 30‐d readmissions.
384 patients were included; 30‐d readmissions were significantly associated with graft loss and death (p = 0.001). Diabetes (p = 0.049), pharmacist identification of poor understanding or adherence, and prolonged time on hemodialysis prior to transplant were associated with an increased risk of 30‐d readmissions. After controlling for risk factors, readmission rates were only independently predicted by pharmacist identification of patient lack of understanding or adherence regarding post‐transplant medications and dialysis exposure for more than three yr (OR 2.3, 95% CI 1.10–4.71, p = 0.026 and OR 2.1, 95% CI 1.22, 3.70, respectively), both of which were significantly modified by history of diabetes.
Thirty‐d readmissions are attributable to both patient and process‐level factors. These data suggest that a lack of post‐transplant medication knowledge in high‐risk patients drives early hospital readmission.