Comparison of Mortality Between Private For-Profit and Private Not-For-Profit Hemodialysis Centers

Devereaux, P. J.; Schünemann, Holger J.; Ravindran, Nikila C.; Bhandari, Mohit; Garg, Amit; Choi, P.; Grant, Brydon J. B.; Haines, Ted; Lacchetti, Christina; Weaver, Bruce; Lavis, John N.; Cook, Deborah J.; Haslam, David; Sullivan, Terrence; Guyatt, Gordon

doi:10.1001/jama.288.19.2449

Cited by 171 publications

(144 citation statements)

References 25 publications

Supporting

Mentioning

132

Contrasting

Unclassified

Order By: Relevance

“…We were also unable to take into account care provided by the examined nephrologists to HD patients outside our study cohort during the study period. Fifth, our data were restricted to patients who receive treatment in for-profit dialysis units in an urban Californian region 30,31 and thus may not be generalizable to patients receiving care in not-for-profit dialysis units or those residing in other United States regions. Finally, our available study data and methods did not allow us to control for provider vintage, number of provider encounters per month, presence of ancillary providers (such as nurse practitioners or physician assistants), or association with academic centers where fellows may participate in dialysis patient care.…”

Section: Discussionmentioning

confidence: 99%

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Harley

Streja

Rhee

et al. 2013

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Physician caseload may be a predictor of patient outcomes associated with various medical conditions and procedures, but the association between patient-physician ratio and mortality among patients undergoing hemodialysis has not been determined. We examined whether a higher patient-nephrologist ratio affects patient mortality risk using de-identified data from DaVita dialysis clinics and the U.S. Renal Data System. A total of 41 nephrologists with a caseload of 50-200 hemodialysis patients from an urban California region were retrospectively ranked according to their hemodialysis patient mortality rate during a 6-year period between 2001 and 2007. We calculated all-cause mortality hazard ratios for each nephrologist and compared patient-and provider-level characteristics between the 10 nephrologists with the highest patient mortality rates and the 10 nephrologists with the lowest patient mortality rates. Nephrologists with the lowest patient mortality rates had significantly lower patient caseloads than nephrologists with the highest mortality rates (median [interquartile range], 65 [55-76] versus 103 [78-144] patients per nephrologist, respectively; P,0.001). Additionally, patients treated by nephrologists with the lowest patient mortality rates received higher dialysis doses, had longer sessions, and received more kidney transplants. In demographic characteristic-adjusted analyses, each 50-patient increase in caseload was associated with a 2% increase in patient mortality risk (hazard ratio, 1.02; 95% confidence interval, 1.00 to 1.04; P,0.001). Hence, these results suggest that nephrologist caseload influences hemodialysis patient outcomes, and future research should focus on identifying the factors underlying this association.

show abstract

Section: Discussionmentioning

confidence: 99%

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Harley

Streja

Rhee

et al. 2013

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Lee et al found that Medicare beneficiaries in for-profit dialysis facilities spent on average 17% more days in the hospital (roughly equivalent to 3 days annually) compared with patients in nonprofit facilities (6). Other studies have examined the association between profit status and death, with mixed results (3,7,10,11). Proposed mechanisms by which profit status and organizational structure may be linked to adverse outcomes include differences in staffing, training level of staff, and specific differences in treatment or processes of care such as hemodialysis session length and medication dosing protocols (3,12).…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review and meta-analysis examining data from 1973 through 1997 found for-profit hemodialysis care to be associated with a higher risk of mortality (3). When more recent data from 2004 through 2006 were examined, Zhang et al also found a higher risk of mortality among patients on hemodialysis receiving care at for-profit, free-standing dialysis facilities (4).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Hospitalization Rates among For-Profit and Nonprofit Dialysis Facilities

Dalrymple¹,

Johansen

Romano³

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives The vast majority of US dialysis facilities are for-profit and profit status has been associated with processes of care and outcomes in patients on dialysis. This study examined whether dialysis facility profit status was associated with the rate of hospitalization in patients starting dialysis.Design, setting, participants, & methods This was a retrospective cohort study of Medicare beneficiaries starting dialysis between 2005 and 2008 using data from the US Renal Data System. All-cause hospitalization was examined and compared between for-profit and nonprofit dialysis facilities through 2009 using Poisson regression. Companion analyses of cause-specific hospitalization that are likely to be influenced by dialysis facility practices including hospitalizations for heart failure and volume overload, access complications, or hyperkalemia were conducted.Results The cohort included 150,642 patients. Of these, 12,985 (9%) were receiving care in nonprofit dialysis facilities. In adjusted models, patients receiving hemodialysis in for-profit facilities had a 15% (95% confidence interval [95% CI], 13% to 18%) higher relative rate of hospitalization compared with those in nonprofit facilities. Among patients receiving peritoneal dialysis, the rate of hospitalization in for-profit versus nonprofit facilities was not significantly different (relative rate, 1.07; 95% CI, 0.97 to 1.17). Patients on hemodialysis receiving care in for-profit dialysis facilities had a 37% (95% CI, 31% to 44%) higher rate of hospitalization for heart failure or volume overload and a 15% (95% CI, 11% to 20%) higher rate of hospitalization for vascular access complications.Conclusions Hospitalization rates were significantly higher for patients receiving hemodialysis in for-profit compared with nonprofit dialysis facilities.

show abstract

“…Although these hypotheses cannot be proven with the available data, these observations raise the question whether financial bias influences the transfer patterns of patients with VDRF. Because previous literature has demonstrated worse outcomes in for-profit hospitals for a variety of conditions, including heart disease (31) and end-stage renal disease requiring dialysis (32,33), it is important to further study the reasons for this discrepant transfer practice to understand the degree to which hospital mission and financial factors influence clinical decision making and outcomes.…”

Section: Original Researchmentioning

confidence: 99%

Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure

et al. 2017

View full text Add to dashboard Cite

Rationale: Patients with ventilator-dependent respiratory failure have improved outcomes at centers with greater expertise; yet, most patients are not treated in such facilities. Efforts to align care for respiratory failure and hospital capability would necessarily require interhospital transfer.Objectives: To characterize the prevalence and the patient and hospital factors associated with interhospital transfer of adults residing in Florida with ventilator-dependent respiratory failure.Methods: We performed a retrospective, observational study using Florida Healthcare Cost and Utilization Project data. We selected patients 18 years of age and older with International Classification of Diseases, Ninth Revision, codes of respiratory failure and mechanical ventilation during 2012 and 2013, and we identified cohorts of patients that did and did not undergo interhospital transfer. We obtained patient sociodemographic and clinical variables and categorized hospitals into subtypes on the basis of patient volume and services provided: large, medium (nonprofit or for-profit), and small.Results: Interhospital transfer was our primary outcome measure. Patient sociodemographics, clinical variables, and hospital types were used as covariates. We identified 2,580 patients with ventilatordependent respiratory failure who underwent interhospital transfer. Overall, transfer was uncommon, with only 2.9% of patients being transferred. In a hierarchical model, age less than 65 years (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.77-2.45) and tracheostomy (OR, 3.19; 95% CI, 2.80-3.65) were associated with higher odds of transfer, whereas having Medicaid was associated with lower odds of transfer than having commercial insurance (OR, 0.65; 95% CI, 0.56-0.75). Additionally, care in medium-sized for-profit hospitals was associated with lower odds of transfer (OR, 1.37 vs. 2.70) than care in medium nonprofit hospitals, despite similar hospital characteristics. Conclusions:In Florida, interhospital transfer of patients with ventilator-dependent respiratory failure is uncommon and more likely among younger, commercially insured, medically resourceintensive patients. For-profit hospitals are less likely to transfer than nonprofit hospitals. In future studies, researchers should test for geographic variations and examine the clinical implications of selectivity in interhospital transfer of patients with ventilatordependent respiratory failure.

show abstract

Comparison of Mortality Between Private For-Profit and Private Not-For-Profit Hemodialysis Centers

Abstract: Hemodialysis care in private not-for-profit centers is associated with a lower risk of mortality compared with care in private for-profit centers.

Cited by 171 publications

References 25 publications

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort

Comparison of Hospitalization Rates among For-Profit and Nonprofit Dialysis Facilities

Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure

Contact Info

Product

Resources

About