Dialysis Facility and Patient Characteristics Associated with Utilization of Home Dialysis

Abstract

Background and objectives: Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources.Design, setting, participants, & measurements: Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network's annual reports. Facility characteristic data were collected from Medicare's Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics.Results: The utilization of home dialysis was positively associated with facility size, percent patients employed full-or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code.Conclusions: Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive.

Socioeconomic Differences in the Uptake of Home Dialysis

“…HHD is more common among advantaged areas (37) in the United Kingdom and white and employed patients in the United States (12). The small number of HHD patients in our registry limits the power of our analyses and the generalizability of our results.…”

“…Prakash et al (11) found no association between area socioeconomic status (SES) and either eligibility for PD or insertion of PD catheter in Canada. HHD was associated with full-time employment and white race in the United States (12). Associations between SES and home dialysis have not been investigated in Australia, a country with comparatively high rates of home dialysis (especially HHD) (13) and universal access to health care.…”

Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States

“…Each minority group was significantly younger and had a lower prevalence of coexisting cardiovascular illnesses, factors generally associated with a greater use of home dialysis. 5,[12][13][14] Moreover, there were no meaningful differences in laboratory parameters as surrogate measures of health to explain the lower use of home dialysis. In the absence of demographic and clinical variables explaining the differential use, it is likely that these differences may arise from patient preferences, social differences (such as sufficient space at home and ability to afford the incremental expense of utilities), or factors associated with health care delivery (such as availability of predialysis nephrology care or home dialysis in communities where minorities live) or physician or provider perception of patients' ability to perform home dialysis.…”

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

“…Those who initiate hemodialysis (HD) face long travel times, which has been associated with worse mortality (5). Despite the importance of PD as an alternative modality in this population, PD units are increasingly consolidating to urban areas (6), rural units are less likely to offer home modalities (7), and rural units with PD programs have worse overall outcomes (8). Previous studies that examined the association of rural and micropolitan living on mortality and likelihood of kidney transplantation have had conflicting findings (9-12); most show little or no difference in outcomes compared with urban populations.…”