Anemia, Mortality
Conditions
Keywords
ESRD, Anemia, Hospitalizations, Mortality
Brief summary
The investigators hypothesize that the post-hospitalized patient status is characterized by subacute and reversible metabolic and hematological changes that, if addressed and treated in a timely manner, would result in a reduced risk for repeat hospitalization. Consequently, a structured quality improvement program, focused on increasing adherence to company wide anemia management policies (ie hemoglobin monitoring within the first 3-5 days post-hospitalization, followed by an appropriate EPO dose modification within the 7 days post-hospitalization), will significantly decrease the risk of hospital re-admission in the 30 days after discharge.
Detailed description
The post-hospitalization quality improvement project will be piloted across 30 Fresenius clinics. Targeted enrollment of 1500 episodes of hospitalization in which the patient returns after discharge to resume outpatient dialysis. Patient outcomes will be followed for up to 30 days from the time of discharge from hospital.
Interventions
OTHEREarly anemia diagnosis and treatment
Patients returning to the unit are immediately assessed and treated for anemia
OTHERNo change from normal routine
Normal unit policy for labs and anemia treatment
Sponsors
Fresenius Medical Care North America
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age ≥ 18 * resumption of routine outpatient chronic hemodialysis within three days of discharge from hospital admission * enrolled in a facility-based anemia management program
Exclusion criteria
* enrolled in hospice * previous hospitalization within the past 30 days (ie. patients discharged from a repeat hospitalization) * anticipated discharge from the outpatient dialysis facility within 30 days (ie anticipated transfer to another facility or hospice)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| composite of death or repeat hospitalization within the 30 days after discharge from a previous hospitalization | one year to accumulate 1500 hospitalizations |
Secondary
| Measure | Time frame |
|---|---|
| hemoglobin, transferrin saturation, albumin, white blood cell count, and C-reactive protein* levels measured in the period following hospitalization and change relative to values measured prior to hospitalization (where available). | one year to accumulate 1500 hospitalizations |
Countries
United States
Outcome results
None listed