Dialysis Facility Characteristics and Variation in Employment Rates

Abstract

Background: Investigation of factors associated with variation in dialysis patient employment has focused primarily on patient-level factors. Little is known about facility-level factors that may be associated with patient employment.Design, setting, participants, and measurements: The ESRD Facility Survey (CMS-2744A) began in 2004 to collect counts of employed patients aged 18 to 54, in addition to dialysis unit census, types and timing of treatments offered, and staffing. Using the 2004 ESRD Facility Survey File, we investigated dialysis unit characteristics and facility employment rate of patients aged 18 to 54 in a logistic regression analysis that included hospital-based chronic renal care facilities, nonhospital renal disease treatment centers, independent special purpose renal dialysis facilities, and renal disease treatment centers.Results: Across all facilities, 18.9% of prevalent patients aged 18 to 54 were employed, but facility employment rates ranged from 0 to 100%. Facility employment rate was positively associated independently with availability of a 5 p.m. or later dialysis shift (odds ratio (OR) 1.54, 95% confidence interval (CI) 1.42 to 1.68), availability of peritoneal dialysis or home hemodialysis (HD) training (OR 1.19, 95% CI 1.11 to 1.28), and provision of frequent HD (OR 1.26, 95% CI 1.07 to 1.49), after adjusting for patient/social worker ratio, rurality of unit location, and unit size. In addition, patient receipt of Vocational Rehabilitation (VR) services was more often reported in facilities with higher employment rates.Conclusions: Promoting gainful employment among ESRD patients continues to be a quality improvement need. A dataset that allows adjustment for patient-level variables would facilitate increased understanding of the contribution of dialysis facility variables to patient employment.

Factors Affecting Employment at Initiation of Dialysis

“…In contrast, those who had not retained the same level of employment from 6 months before kidney failure were more likely to choose HD. Although it could be argued that those chose PD were more educated and more motivated to keep their employment, this finding is consistent with findings from previous studies (13,14). In general, PD allows more flexibility and control over one's treatment schedule and is associated with higher patient satisfaction than in-center hemodialysis (15,16).…”

Depressed Mood, Usual Activity Level, and Continued Employment after Starting Dialysis

“…The analyses that we report do not include facility-level factors that may influence patients' employment, although the analyses do take into account the effect of patient clustering in facilities as a result of the sampling design. We previously showed that dialysis clinic-specific employment rates are positively associated with availability of a late (5 p.m. or later) HD treatment shift, availability of PD or home HD training, and provision of frequent HD and that in facilities with the highest employment rates, patients are more likely to receive vocational rehabilitation services (19).…”

“…Most people can earn much more money by working than they would receive from disability, however. Vocational counselors can help individuals who require dialysis with decisions about balancing the financial rewards that they can expect from employment versus receipt of disability benefits (18), and dialysis facilities with the highest employment rates are more likely to have patients who receive vocational rehabilitation services (19). Under the Ticket to Work and Work Incentives Improvement Act of 1999, people may be able to retain Medicaid coverage when they become employed.…”

Dialysis Facility and Patient Characteristics Associated with Utilization of Home Dialysis

“…We are unable to further define an answer for the question of whether dialysis choice influences employment status or if employment status influences dialysis choice. This question was recently explored elsewhere (16,21). Age may or may not be associated with working status.…”