Despite national emphasis on hospital readmission reduction among dialysis patients, the health information technology infrastructure needed to facilitate this reduction is sorely lacking. U.S. dialysis facilities and hospitals generally use different electronic health records, and without this direct avenue for communication between providers, essential components of successful care are frequently not transmitted to the outpatient dialysis facility, increasing hospital readmission risk. Similarly, hospitals also may not receive adequate, timely patient information from dialysis facilities needed to provide high-quality, appropriate care at admission or during hospitalization. Ongoing quality improvement efforts at Emory can be leveraged into a pragmatic research study, to address this gap and produce a practical, potentially sustainable strategy to reduce hospital readmissions among this high-risk population via an effectiveness-implementation hybrid design. We will leverage an existing multidisciplinary team (hospitalists, nephrologists, nurses, administrators) already working to reduce readmissions among dialysis patients at Emory University Hospital Midtown, as well as our established research team at Emory Dialysis. Our team will modify an existing, secure, web-based platform that allows dialysis facilities to communicate directly with transplant centers regarding referrals and patient status. We will then evaluate this modified platform (?DialysisConnect?), which will allow exchange of discharge summaries, send automated reminders to providers to view the discharge summaries, and track views of discharge summaries. Importantly, DialysisConnect will also allow direct communication between hospitals and dialysis facilities, so that specific, critical information?beyond that found on typical discharge summaries? such as the dry weight and medication lists, can be transmitted from hospital to dialysis facility and vice versa.
We aim : (1) to determine essential components for two-way, peri-hospitalization, standardized communication between hospitals and dialysis facilities, via open-ended input via focus groups with potential DialysisConnect users; (2) to develop DialysisConnect, which will allow direct communication between dialysis facilities and hospitals at admission and during and after hospitalizations of dialysis patients and will be modified from an existing platform currently being tested in our dialysis facilities and area transplant centers; and (3) to simultaneously evaluate the effectiveness of DialysisConnect and its potential for sustained and wider implementation in a hybrid pragmatic trial. Because this pragmatic study will be implemented in our outpatient dialysis facilities and the hospital at which most of our dialysis population admissions occur, it could improve healthcare practice regarding hospitalizations in the local, high-risk dialysis population in a sustainable way. Additionally, DialysisConnect will provide an innovative and adaptable model of healthcare delivery that could improve care and hospitalization outcomes for dialysis patients treated at facilities and hospitals nationwide.

Public Health Relevance

Improving outcomes of hospitalized dialysis patients requires direct communication between hospital and dialysis providers, which is difficult in our fragmented healthcare system. Our study aims to develop a secure, web-based platform that can be used to exchange pertinent, real-time health information about hospitalized dialysis patients between hospitals and outpatient dialysis facilities, as well as evaluate its effectiveness and potential for wider, sustained use. This pragmatic study will provide an innovative and adaptable model of healthcare delivery that could improve hospitalization outcomes for dialysis patients treated at facilities and hospitals nationwide.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18DK118467-02
Application #
9774041
Study Section
Special Emphasis Panel (ZDK1)
Program Officer
Narva, Andrew
Project Start
2018-09-01
Project End
2021-07-31
Budget Start
2019-08-01
Budget End
2020-07-31
Support Year
2
Fiscal Year
2019
Total Cost
Indirect Cost
Name
Emory University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322