Comparison of hospitalization rates among for-profit and nonprofit dialysis facilities

Lorien Dalrymple, Kirsten L. Johansen, Patrick S Romano, Glenn M. Chertow, Yi Mu, Julie H. Ishida, Barbara Grimes, George Kaysen, Danh V. Nguyen

Research output: Contribution to journalArticle

20 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)73-81
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume9
Issue number1
DOIs
StatePublished - Jan 7 2014

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Dialysis
Hospitalization
Confidence Intervals
Renal Dialysis
Cardiac Volume
Heart Failure
Hyperkalemia
Peritoneal Dialysis
Medicare
Information Systems
Blood Vessels
Cohort Studies
Retrospective Studies
Kidney

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 journalArticle

Dalrymple, Lorien ; Johansen, Kirsten L. ; Romano, Patrick S ; Chertow, Glenn M. ; Mu, Yi ; Ishida, Julie H. ; Grimes, Barbara ; Kaysen, George ; Nguyen, Danh V. / Comparison of hospitalization rates among for-profit and nonprofit dialysis facilities. In: Clinical Journal of the American Society of Nephrology. 2014 ; Vol. 9, No. 1. pp. 73-81.
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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.",
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