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Table 3 Association of attainment of 6-month clinical performance targets with hospital admissions and hospital days

From: Attainment of clinical performance targets and improvement in clinical outcomes and resource use in hemodialysis care: a prospective cohort study

Target

Average per follow-up year*

Incidence Rate Ratio (95% Confidence Interval)

  

Unadjusted

Multivariate Adjusted**

Propensity Score Adjusted***

NUMBER OF HOSPITALIZATIONS

Individual Targets

Albumin ≥4.0 g/dl (N = 650)

    

   Target not attained

2.2

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

1.4

0.62 (0.57–0.67)

0.67 (0.62–0.73)

0.81 (0.73–0.89)

   P

<0.001

<0.001

0.001

<0.001

Ca-P Product <55 mg2/dl2 (N = 648)

    

   Target not attained

2.1

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

1.9

0.88 (0.82–0.95)

0.86 (0.79–0.92)

0.80 (0.74–0.86)

   P

0.374

0.001

<0.001

<0.001

Hemoglobin ≥11 g/dl (N = 644)

    

   Target not attained

2.1

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

1.8

0.85 (0.79–0.91)

0.82 (0.76–0.88)

0.81 (0.75–0.87)

   P

0.146

<0.001

<0.001

<0.001

Dialysis Dose, Kt/V≥1.2 (N = 539)

    

   Target not attained

1.9

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

1.9

1.00 (0.89–1.13)

0.99 (0.88–1.12)

0.86 (0.75–0.99)

   P

0.796

0.970

0.902

0.040

Access Type, fistula (N = 424)

    

   Target not attained

2.0

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

1.4

0.73 (0.66–0.81)

0.79 (0.71–0.88)

0.86 (0.77–0.97)

   P

0.016

<0.001

<0.001

0.011

Albumin, Ca-P, and Hemoglobin Targets (N = 643)

0 targets attained

2.6

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

1 target attained

2.1

0.69 (0.61–0.76)

0.69 (0.62–0.78)

0.59 (0.53–0.66)

2 targets attained

1.8

0.62 (0.56–0.70)

0.62 (0.55–0.69)

0.57 (0.51–0.65)

3 targets attained

1.3

0.43 (0.37–0.50)

0.44 (0.38–0.51)

0.39 (0.33–0.46)

P for trend

<0.001

<0.001

<0.001

<0.001

All Five Targets (N = 344)

0–1 targets attained

2.4

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

2 targets attained

2.3

0.96 (0.82–1.14)

0.88 (0.74–1.05)

1.01 (0.85–1.19)

3 targets attained

1.7

0.71 (0.60–0.84)

0.67 (0.57–0.80)

0.76 (0.64–0.90)

4–5 targets attained

1.1

0.55 (0.45–0.66)

0.55 (0.43–0.67)

0.65 (0.53–0.80)

P for trend

<0.001

<0.001

<0.001

<0.001

DAYS HOSPITALIZED

Individual Targets

Albumin ≥4.0 g/dl (N = 647)

    

   Target not attained

13.0

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

7.4

0.55 (0.53–0.57)

0.61 (0.58–0.63)

0.76 (0.72–0.79)

   P

<0.001

<0.001

<0.001

<0.001

Ca-P Product <55 mg2/dl2 (N = 645)

    

   Target not attained

11.6

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

11.1

0.89 (0.87–0.92)

0.85 (0.83–0.88)

0.79 (0.77–0.82)

   P

0.719

<0.001

<0.001

<0.001

Hemoglobin ≥11 g/dl (N = 641)

    

   Target not attained

11.7

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

11.0

0.92 (0.90–0.95)

0.89 (0.86–0.92)

0.89 (0.86–0.91)

   P

0.571

<0.001

<0.001

<0.001

Dialysis Dose, Kt/V≥1.2 (N = 537)

    

   Target not attained

9.3

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

11.6

1.12 (1.06–1.18)

1.11 (1.05–1.17)

0.89 (0.84–0.95)

   P

0.225

<0.001

<0.001

<0.001

Access Type, fistula (N = 420)

    

   Target not attained

12.3

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

   Target attained

7.3

0.65 (0.62–0.67)

0.72 (0.69–0.75)

0.79 (0.75–0.82)

   P

0.004

<0.001

<0.001

<0.001

Albumin, Ca-P, and Hemoglobin Targets (N = 640)

0 targets attained

13.9

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

1 target attained

11.7

0.69 (0.66–0.72)

0.70 (0.67–0.73)

0.61 (0.59–0.64)

2 targets attained

11.9

0.70 (0.67–0.73)

0.70 (0.66–0.73)

0.67 (0.63–0.70)

3 targets attained

6.0

0.37 (0.34–0.39)

0.37 (0.35–0.40)

0.35 (0.33–0.38)

P for trend

0.001

<0.001

<0.001

<0.001

All Five Targets (N = 341)

0–1 targets attained

13.2

1.00 (Ref.)

1.00 (Ref.)

1.00 (Ref.)

2 targets attained

14.3

0.95 (0.89–1.01)

0.87 (0.82–0.94)

1.00 (0.94–1.07)

3 targets attained

10.4

0.71 (0.66–0.75)

0.67 (0.63–0.72)

0.77 (0.72–0.83)

4–5 targets attained

4.8

0.41 (0.38–0.44)

0.43 (0.40–0.47)

0.50 (0.46–0.55)

P for trend

<0.001

<0.001

<0.001

<0.001

  1. For hospital admissions, mean at-risk follow-up (excluding days in the hospital when patients could not be admitted) was 3.1 years (median, 3.0 years); for hospital days, mean at-risk follow-up was 3.2 years (median, 3.1 years). Statistically significant values are in boldface type.
  2. *P by t test (individual targets) or nonparametric trend test (multiple targets).
  3. **Adjusted for first value of target(s) indicated, age, race, index of co-existent disease, and albumin.
  4. ***Propensity score models consisted of:
  5. Albumin target: age, sex, index of co-existent disease, baseline albumin, creatinine, and C-reactive protein;
  6. Ca-P target: age, sex, employment, index of co-existent disease, creatinine, hemoglobin, and baseline Ca-P;
  7. Hemoglobin target: age, sex, race, body mass index, and baseline hemoglobin;
  8. Dialysis dose target: age, sex, race, body mass index, Kt/V, creatinine, hemoglobin, and Ca-P;
  9. Access target: age, sex, race, index of co-existent disease, albumin, creatinine, and C-reactive protein;
  10. Albumin, Ca-P, and hemoglobin targets: age, sex, index of co-existent disease, body mass index, baseline albumin, baseline hemoglobin, baseline Ca-P, and C-reactive protein; and
  11. All five targets: age, sex, index of co-existent disease, body mass index, baseline Kt/V, baseline albumin, baseline hemoglobin, baseline Ca-P, and C-reactive protein.
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BMC Health Services Research

ISSN: 1472-6963

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