Use of a Patient Portal Decreases Hospital Admission Rates

San Diego–Clinical status of patients on peritoneal dialysis are commonly assessed only once a month, limiting the clinician’s view of the state of the patient’s health. A large dialysis provider has launched a connected health program to enable patients on peritoneal dialysis to enter their clinical parameters or concerns daily. The portal provides automated alerts to clinicians for abnormal findings; patient nonadherence to reporting  also triggers an alert to the clinician.

Carlos Muchiutti and colleagues at Fresenius Medical Care North America, Waltham, Massachusetts, recently conducted a comparison of outcomes (hospital admissions and modality failure) between patients using the portal and patients not using the portal. Results of the comparison were reported during a poster session at Kidney Week 2018 in a poster titled Association Between Use of a Patient Portal with Hospitalization Rates and Modality Failure in Peritoneal Dialysis Patients.

The comparison included data on 5549 active peritoneal dialysis patients who were introduced to the patient portal prior to September 30, 2017. Inclusion criteria were ≤10 hospitalization days in September 2017. The engaged group was defined as those who documented data for ≥20 hospitalizations during September 2017 (n=1199). The remaining 4350 patients did not document any treatment data on the portal and were defined as the non-engaged group. Patients who documented data on >0 and <20 treatments were excluded from the analysis.

Follow-up continued for 6 months starting September 30, 2017, until the earliest discharge date from the clinic (including death), transition from peritoneal dialysis to hemodialysis, or the end of the follow-up period. Chi-square test was used to compare the percent of patients who transitioned from peritoneal dialysis to hemodialysis without accounting for the length of follow-up. Poisson regression model, adjusted for prior hospitalizations, was used to compare the hospitalization rate during the follow-up period.

There was a 20% lower risk of hospitalization in the engaged group compared with the non-engaged group (relative risk, 0.8; P<.001). There was no significant difference in modality changes from peritoneal dialysis to hemodialysis between the two groups (11% engaged patients vs 13% non-engaged patients; P=.11).

In conclusion, the researchers said, “Consistent documentation of treatment data in the patient portal was associated with lower hospital admission rates among peritoneal dialysis 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.”

Source; Muchiutti C, Fore B, Chaudhuri S, et al. Associations between use of a patient portal with hospitalization rates and modality failure in peritoneal dialysis patients. Abstract of a poster (FR-PO686) presented at the American Society of Nephrology Kidney Week 2018, October 26, 2018, San Diego, California.