Kidney Week

Abstract: FR-PO686

Associations Between Use of a Patient Portal with Hospitalization Rates and Modality Failure in Peritoneal Dialysis Patients

Session Information

• Dialysis: Peritoneal Dialysis - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Muchiutti, Carlos, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Carlos Muchiutti,

• Fore, Bryan, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Bryan Fore,

• Chaudhuri, Sheetal, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Sheetal Chaudhuri,

• Rosen, Sophia, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Sophia Rosen,

• Han, Hao, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Hao Han,

• Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Marta Reviriego-Mendoza,

• Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States

John W. Larkin,

• Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Len A. Usvyat,

• Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Franklin W. Maddux,

Background

Peritoneal dialysis (PD) patients often have their clinical status assessed monthly, which limits the clinicians view of the patients’ health state. A large dialysis provider has recently constructed a connected health program for PD patients to enter their clinical parameters or complaints daily. This portal provides automated alerts to clinicians for abnormal findings, as well as non-adherence with reporting. We analysed outcomes for hospital admission rate and modality failure in patients who were using the portal versus those who were not.

Methods

We included data from 5549 active PD patients who were introduced to the patient portal prior to Sep 30, 2017 and had <=10 hospitalizations days in Sep 2017. Patients who documented data for ≥20 treatments during Sep 2017 were considered “the engaged group” (n=1199). The remaining 4350 patients who did not document any treatment data on the portal were considered “the non-engaged group.” Patients who documented data on >0 and <20 treatments were not included in this analysis. Patients were followed 6 months starting Sep 30, 2017 up until the earliest of discharge from the clinic (including death), switch from PD to hemodialysis (HD) or end of follow-up. We compared the percent of patients who switched modality from PD to HD using Chi-square test without accounting for the length of follow-up. We compared the hospital admission rate during follow-up period using Poisson regression model adjusted for prior hospitalizations.

Results

We observed that patients in “the engaged group” had a 20% lower risk of hospitalization compared to the “non-engaged group” (Relative Risk=0.8, p<0.001). We found no significant difference in modality changes from PD to HD between groups (11% engaged patients vs 13% non-engaged patients, p=0.11).

Conclusion

Consistent documentation of treatment data in the patient portal was associated with lower hospital admission rates among PD patients suggesting that better patient engagement as well as more real-time clinician involvement may impact patients’ hospitalization rates. However, observations may be confounded by indication of portal use, which could represent a more adherent group of patients. Further analysis is needed to confirm these findings.