Provider visit frequency and vascular access interventions in hemodialysis

Kevin F. Erickson, Matthew Mell, Wolfgang C. Winkelmayer, Glenn M. Chertow, Jay Bhattacharya

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background and objectives Medicare reimbursement policy encourages frequent provider visits to patients with ESRD undergoing hemodialysis. This study sought to determine whether more frequent face-to-face provider (physician and advanced practitioner) visits lead to more procedures and therapeutic interventions aimed at preserving arteriovenous fistulas and grafts, improved vascular access outcomes, and fewer related hospitalizations. Design, setting, participants, & measurements Multivariable regression was used to evaluate the association between provider (physician and advanced practitioner) visit frequency and interventions aimed at preserving vascular access, vascular access survival, hospitalization for vascular access infection, and outpatient antibiotic use in a cohort of 63,488 Medicare beneficiaries receiving hemodialysis in the United States. Medicare claims were used to identify the type of vascular access used, access-related events, and vascular access failure. Results One additional provider (physician and advanced practitioner) visit per month was associated with a 13% higher odds of receiving an intervention to preserve vascular access (95% confidence interval [95% CI], 12% to 14%) but was not associated with vascular access survival (hazard ratio, 1.01; 95% CI, 0.99 to 1.03). One additional provider visitwas associatedwith a 9%(95%CI, 5% to 14%) lower odds of hospitalization for vascular access infection and a corresponding 9% (95% CI, 5% to 14%) higher odds of outpatient intravenous antibiotic administration. However, the associated changes in absolute probabilities of hospitalization and antibiotic administration were small. Conclusions More frequent face-to-face provider (physician and advanced practitioner) visits were associated with more procedures and therapeutic interventions aimed at preserving vascular accesses, but not with prolonged vascular access survival and only a small decrease in hospitalization for vascular access.

Original languageEnglish (US)
Pages (from-to)269-277
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number2
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Blood Vessels
Renal Dialysis
Hospitalization
Medicare
Physicians
Confidence Intervals
Anti-Bacterial Agents
Outpatients
Survival
Arteriovenous Fistula
Infection
Intravenous Administration
Chronic Kidney Failure
Transplants

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Provider visit frequency and vascular access interventions in hemodialysis. / Erickson, Kevin F.; Mell, Matthew; Winkelmayer, Wolfgang C.; Chertow, Glenn M.; Bhattacharya, Jay.

In: Clinical Journal of the American Society of Nephrology, Vol. 10, No. 2, 01.01.2015, p. 269-277.

Research output: Contribution to journalArticle

Erickson, Kevin F. ; Mell, Matthew ; Winkelmayer, Wolfgang C. ; Chertow, Glenn M. ; Bhattacharya, Jay. / Provider visit frequency and vascular access interventions in hemodialysis. In: Clinical Journal of the American Society of Nephrology. 2015 ; Vol. 10, No. 2. pp. 269-277.
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abstract = "Background and objectives Medicare reimbursement policy encourages frequent provider visits to patients with ESRD undergoing hemodialysis. This study sought to determine whether more frequent face-to-face provider (physician and advanced practitioner) visits lead to more procedures and therapeutic interventions aimed at preserving arteriovenous fistulas and grafts, improved vascular access outcomes, and fewer related hospitalizations. Design, setting, participants, & measurements Multivariable regression was used to evaluate the association between provider (physician and advanced practitioner) visit frequency and interventions aimed at preserving vascular access, vascular access survival, hospitalization for vascular access infection, and outpatient antibiotic use in a cohort of 63,488 Medicare beneficiaries receiving hemodialysis in the United States. Medicare claims were used to identify the type of vascular access used, access-related events, and vascular access failure. Results One additional provider (physician and advanced practitioner) visit per month was associated with a 13{\%} higher odds of receiving an intervention to preserve vascular access (95{\%} confidence interval [95{\%} CI], 12{\%} to 14{\%}) but was not associated with vascular access survival (hazard ratio, 1.01; 95{\%} CI, 0.99 to 1.03). One additional provider visitwas associatedwith a 9{\%}(95{\%}CI, 5{\%} to 14{\%}) lower odds of hospitalization for vascular access infection and a corresponding 9{\%} (95{\%} CI, 5{\%} to 14{\%}) higher odds of outpatient intravenous antibiotic administration. However, the associated changes in absolute probabilities of hospitalization and antibiotic administration were small. Conclusions More frequent face-to-face provider (physician and advanced practitioner) visits were associated with more procedures and therapeutic interventions aimed at preserving vascular accesses, but not with prolonged vascular access survival and only a small decrease in hospitalization for vascular access.",
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