Poor access to care, high comorbid condition burden correlates with increased ED use
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Patients on hemodialysis are likely to utilize ED care if they have limited access to care and high comorbid condition burdens, according to data published in Kidney Medicine.
“Because hemodialysis (HD) patients appear to be the greatest ED utilizers among patients with end-stage kidney disease and are the largest subset of the ESKD patient population, understanding ED utilization by HD patients is a critical step toward reaching these initiatives’ goals,” Gregory Han, BA, from the department of emergency medicine at Weill Cornell Medicine in New York, and colleagues wrote.
In a systematic review of 38 studies published until April 2020, researchers explored predictors and interventions for ED utilization in patients on HD. All studies came from Ovid MEDLINE, Ovid Embase or the Cochrane Library, and were either randomized controlled trials or observational studies. Researchers performed narrative synthesis to form subgroup concept themes.
Among the 38 studies, 34 studies analyzed predictors of ED utilization and the remaining four studies evaluated interventions in which ED utilization was studied. The narrative synthesis revealed eight concept subgroups: dialysis, social determinants of health, undocumented immigrant populations, medications and adverse drug events, laboratory values and scoring forms, psychiatric illness, palliative care and new financial models.
Researchers determined that limited access to care and a high comorbid condition burden correlated with increased ED use. While no studies identified ED-based interventions to reduce ED utilization, recent health care changes are linked with improved outcomes.
“The predictors we have compiled in this review provide rich ground for the development of a risk stratification tool to predict future all-cause ED visits by HD patients,” Han and colleagues wrote. They added, “The next step for developing such a tool would be to perform a multivariate analysis on the predictors identified in this study to further our understanding of which predictors best predict increased ED utilization by HD patients.”
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