The significantly higher cost of PRT-treated PLTs over PGD-tested PLTs should interest stakeholders. For hospitals that outdate PLTs, savings associated with expiration extension to 7 days by adding PGD testing will likely be substantially greater than the cost of implementing PGD-testing. Our findings might usefully inform a hospital's decision to select a particular blood safety approach.

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Dialysis vascular access (DVA) care is being increasingly provided in freestanding office-based centers (FOC). Small-scale studies have suggested that DVA care in a FOC results in favorable patient outcomes and lower costs. To further evaluate this issue, data were drawn from incident and prevalent ESRD patients within a 4-year sample (2006-2009) of Medicare claims (USRDS) on cases who receive at least 80% of their DVA care in a FOC or a hospital outpatient department (HOPD). Using propensity score matching techniques, cases with a similar clinical and demographic profile from these two sites of service were matched. Medicare utilization, payments, and patient outcomes were compared across the matched cohorts (n = 27,613). Patients treated in the FOC had significantly better outcomes (p < 0.001), including fewer related or unrelated hospitalizations (3.8 vs. 4.4), vascular access-related infections (0.18 vs. 0.29), and septicemia-related hospitalizations (0.15 vs. 0.18). Mortality rate was lower (47.9% vs. 53.5%) as were PMPM payments ($4,982 vs. $5,566). This study shows that DVA management provided in a FOC has multiple advantages over that provided in a HOPD.

ORIGINAL RESEARCH ARTICLEangioplasties performed on AVF (3). Site of service has also changed progressively toward the freestanding outpatient facility (FOC) dedicated to DVA from hospital outpatient departments (HOPD). In the FOC, fluoroscopically guided, endovascular treatments are being performed, utilizing sedation/ analgesia in an outpatient environment primarily by interventional nephrologists. Questions arise about their effectiveness, safety, quality, and economy.In a previous study (4), based on Medicare claims and United States Renal Data System (USRDS) data from 2006 to 2009, a large cohort of cases receiving DVA management care in an FOC was compared using propensity score matching with a cohort of cases managed in an HOPD. This study showed significantly better outcomes for the FOC setting, including fewer vascular access-related infections, fewer septicemia-related hospital admissions, and fewer related and unrelated hospital admissions than those who received care in a HOPD (p<0.001 for each metric). Furthermore, FOC cases had significantly lower mortality and lower per-member-per-month (PMPM) Medicare payments than HOPD cases.