Between the beginning of 1996 and the end of 2005, there was little change in the admission rate among prevalent dialysis patients. Since the beginning of 2006, however, rates have begun to decline. Among patients alive on January 1, 2006, the rate during the calendar year was more than 2 percent lower than among corresponding patients alive on January 1, 2005. In successive years, year-over-year declines in the rate were typically between 1 and 2 percent, for a cumulative reduction of more than 8 percent between 2005 and 2011. Rates within calendar quarters and months follow strong cyclical patterns, a clear manifestation of seasonality. In recent years, the rate in the first quarter exceeds the corresponding rate in the fourth quarter by 7–10 percent. From this perspective, January and February are clear targets for quality improvement efforts, especially regarding infection control.
Progress has been markedly slower in some parts of the country. Some of these differences might be due to regional variation in influenza intensity, an area that merits further study. Alternatively, in states with much larger patient populations, there may be substantial variation in progress across metropolitan statistical areas within the states.
Hospital Admission Rates Among Prevalent Dialysis Patients, by Annual, Quarterly, & Monthly Cohorts
Hospital Admission Rates, Overall & by U.S. Census Division
HOSPITAL ADMISSION RATES AMONG PREVALENT DIALYSIS PATIENTS
Among Medicare-enrolled dialysis patients on January 1 of each year. Admissions per patient year; APC, Annual Percent Change. Maps show 2011 rates.