Chronic dialysis patients have multiple comorbidities and are frequent users of the health care system. Although dialysis and associated care is well understood, these patients also require unscheduled, urgent and inpatient care (often accounting for 20% of their total health care costs), which is considered to be unpredictable and is not bundled into the funding structure for dialysis care in Ontario.
Together with the Institute for Clinical Evaluative Studies (ICES), we conducted a retrospective cohort study of incident chronic dialysis patients in Ontario from 2004 through 2011. In addition to developing an understanding of the unscheduled utilization and how much may be avoidable, we identified several predictors of unscheduled resource use including being on peritoneal dialysis and having additional comorbidities. We also uncovered large variability between utilization depending on the regional dialysis facility.
Our study was supplied to the Ontario Renal Network with suggestions for funding implications and further areas of study into the reasons for regional variance and whether peritoneal dialysis should be encouraged.
Hannah Wong, ORN, Eric Chow, Graham Woodward, Michael Paterson, Dr. Dante Morra