PMID- 30935119
OWN - NLM
STAT- MEDLINE
DCOM- 20190813
LR  - 20231104
IS  - 1660-4601 (Electronic)
IS  - 1661-7827 (Print)
IS  - 1660-4601 (Linking)
VI  - 16
IP  - 7
DP  - 2019 Mar 31
TI  - Effects of Early Frequent Nephrology Care on Emergency Department Visits among 
      Patients with End-stage Renal Disease.
LID - 10.3390/ijerph16071158 [doi]
LID - 1158
AB  - In this retrospective cohort study, we examined the association between 
      predialysis nephrology care status and emergency department (ED) events among 
      patients with end-stage renal disease. Data pertaining to 76,702 patients who 
      began dialysis treatment between 1999 and 2010 were obtained from the National 
      Health Insurance Research Database of Taiwan (NHIRD). The patients were divided 
      into three groups based on the timing of the first nephrology care visit prior to 
      the initiation of maintenance dialysis, and the frequency of nephrologist visits 
      (i.e., early referral/frequent consultation, early referral/infrequent 
      consultation, late referral). At 1-year post-dialysis initiation, a large number 
      of the patients had experienced at least one all-cause ED visit (58%), 
      infection-related ED visit (17%), or potentially avoidable ED visit (7%). Cox 
      proportional hazard models revealed that patients who received early frequent 
      care faced an 8% lower risk of all-cause ED visit (HR: 0.92; 95% CI: 0.90(-)0.94), 
      a 24% lower risk of infection-related ED visit (HR: 0.76; 95% CI: 0.73(-)0.79), and 
      a 24% lower risk of avoidable ED visit (HR: 0.76; 95% CI: 0.71(-)0.81), compared 
      with patients in the late referral group. With regard to the patients undergoing 
      early infrequent consultations, the only marginally significant association was 
      for infection-related ED visits. Recurrent event analysis revealed generally 
      consistent results. Overall, these findings indicate that continuous nephrology 
      care from early in the predialysis period could reduce the risk of ED utilization 
      in the first year of dialysis treatment.
FAU - Chen, Yun-Yi
AU  - Chen YY
AD  - Institute of Health Policy and Management, College of Public Health, National 
      Taiwan University, Taipei 100, Taiwan. yunyichen@gmail.com.
FAU - Chen, Likwang
AU  - Chen L
AD  - Institute of Population Health Sciences, National Health Research Institutes, 
      Zhunan 350, Taiwan. likwang@nhri.org.tw.
FAU - Huang, Jenq-Wen
AU  - Huang JW
AD  - Division of Nephrology, Department of Internal Medicine, National Taiwan 
      University Hospital, Taipei 100, Taiwan. jenqwen@gmail.com.
FAU - Yang, Ju-Yeh
AU  - Yang JY
AD  - Institute of Health Policy and Management, College of Public Health, National 
      Taiwan University, Taipei 100, Taiwan. yangjuyeh@gmail.com.
AD  - Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City 220, 
      Taiwan. yangjuyeh@gmail.com.
AD  - Department of Quality Management Center, Far Eastern Memorial Hospital, New 
      Taipei City 220, Taiwan. yangjuyeh@gmail.com.
AD  - Lee-Ming Institute of Technology, New Taipei City 243, Taiwan. 
      yangjuyeh@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190331
PL  - Switzerland
TA  - Int J Environ Res Public Health
JT  - International journal of environmental research and public health
JID - 101238455
MH  - Adult
MH  - Aged, 80 and over
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Kidney Failure, Chronic/*therapy
MH  - Male
MH  - Middle Aged
MH  - Office Visits/*statistics & numerical data
MH  - Proportional Hazards Models
MH  - *Renal Dialysis
MH  - Retrospective Studies
MH  - Taiwan
PMC - PMC6479768
OTO - NOTNLM
OT  - avoidable emergency department visits
OT  - chronic kidney disease (CKD)
OT  - dialysis initiation
OT  - early referral
OT  - emergency department visits
OT  - end-stage renal disease (ESRD)
OT  - infection
OT  - predialysis nephrology care
OT  - quality of care
COIS- The authors declare no conflict of interest.
EDAT- 2019/04/03 06:00
MHDA- 2019/08/14 06:00
PMCR- 2019/04/01
CRDT- 2019/04/03 06:00
PHST- 2019/03/11 00:00 [received]
PHST- 2019/03/27 00:00 [revised]
PHST- 2019/03/28 00:00 [accepted]
PHST- 2019/04/03 06:00 [entrez]
PHST- 2019/04/03 06:00 [pubmed]
PHST- 2019/08/14 06:00 [medline]
PHST- 2019/04/01 00:00 [pmc-release]
AID - ijerph16071158 [pii]
AID - ijerph-16-01158 [pii]
AID - 10.3390/ijerph16071158 [doi]
PST - epublish
SO  - Int J Environ Res Public Health. 2019 Mar 31;16(7):1158. doi: 
      10.3390/ijerph16071158.