Estimating the effect of dialysis staffing ratio regulations on mortality and hospitalizations for Medicare hemodialysis patients

Abstract

Background and ObjectivesEight states and Washington, DC have implemented regulations mandating a minimum ratio between treatment staff and patients receiving hemodialysis in a facility in an effort to improve the quality of hemodialysis treatment. Our investigation examines the association between minimum staffing regulations and patient mortality for four states and hospitalizations for two states that implemented these rules during our sample period.Design, Setting, Participants, and MeasurementsWe utilized a synthetic difference in differences estimation to analyze the effect of minimum staffing ratios on hemodialysis treatment quality, measured by deaths and hospitalizations for end‐stage renal disease patients. We used data gathered by the US Renal Data System and aggregated at the state level.ResultsWe are unable to find evidence that mandated dialysis staffing ratios area associated with a reduction in mortality or hospitalizations. We estimate a slight reduction in deaths per 1000 patient hours and a slight increase in hospitalizations, but neither are statistically significant.ConclusionsWe were unable to find evidence that minimum staffing ratios for hemodialysis facilities are associated with improved patient outcomes. Our findings highlight the need for future work, studying the impact of these regulations at the facility level.

Patient Care Technician Staffing in US Hemodialysis Facilities: An Ecological Study

“…Interestingly, the geographic patterns we observed did not necessarily align with existing state mandates for patient care technician staffing. 6 , 7 Among the states with staffing mandates, only Maryland and Oregon had low patient-to-patient care technician ratios in 2019; Massachusetts, Nevada, South Carolina, and Texas had high ratios, whereas Georgia and Utah had very high patient-to-patient care technician ratios. In several cases, the median station-to-patient care technician ratios were low, potentially suggesting high overall patient loads but fewer patients per shift (ie, more shifts per patient care technician).…”

“…This may reflect increasing turnover (patient care technicians moving between facilities, switching from dialysis patient care technician to another job, or retiring). This pattern may also reflect increased hiring efforts by facilities to keep up with the rapidly increasing US in-center population of patients receiving HD (from 301,640 in 2004 to 492,987 prevalent patients in 2019, a 63% increase 8 ), respond to staffing mandates, 6 , 7 and/or meet increasing quality-of-care payment incentives 1 over the same time period. Additionally, median station-to-patient care technician ratios remained fairly consistent from 2004 to 2019.…”

“…Although the number of technicians caring for patients receiving dialysis continues to grow with the patient population (>47,000 technicians caring for patients receiving dialysis in 2018 1 ), and several states have instituted dialysis staffing mandates ( Table S1 ), 6 , 7 little is known about how patient care technician staffing patterns differ across US dialysis facilities. Here, we leverage national data to provide a comprehensive description of dialysis patient care technician staffing patterns and to identify facility characteristics that are associated with differences in staffing of technicians caring for patients receiving dialysis.…”