Abstract
Background 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 73-81 |
| Number of pages | 9 |
| Journal | Clinical Journal of the American Society of Nephrology |
| Volume | 9 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 7 2014 |
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ASJC Scopus subject areas
- Nephrology
- Transplantation
- Epidemiology
- Critical Care and Intensive Care Medicine
Cite this
Comparison of hospitalization rates among for-profit and nonprofit dialysis facilities. / Dalrymple, Lorien; Johansen, Kirsten L.; Romano, Patrick S; Chertow, Glenn M.; Mu, Yi; Ishida, Julie H.; Grimes, Barbara; Kaysen, George; Nguyen, Danh V.
In: Clinical Journal of the American Society of Nephrology, Vol. 9, No. 1, 07.01.2014, p. 73-81.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Comparison of hospitalization rates among for-profit and nonprofit dialysis facilities
AU - Dalrymple, Lorien
AU - Johansen, Kirsten L.
AU - Romano, Patrick S
AU - Chertow, Glenn M.
AU - Mu, Yi
AU - Ishida, Julie H.
AU - Grimes, Barbara
AU - Kaysen, George
AU - Nguyen, Danh V.
PY - 2014/1/7
Y1 - 2014/1/7
N2 - Background 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.
AB - Background 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.
UR - http://www.scopus.com/inward/record.url?scp=84891843376&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84891843376&partnerID=8YFLogxK
U2 - 10.2215/CJN.04200413
DO - 10.2215/CJN.04200413
M3 - Article
C2 - 24370770
AN - SCOPUS:84891843376
VL - 9
SP - 73
EP - 81
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
SN - 1555-9041
IS - 1
ER -