Patients Report Poorer Dialysis Service in Certain Settings

For-profit, free-standing facilities, large-chain facilities tied to lower patient scores
For-profit, free-standing facilities, large-chain facilities tied to lower patient scores

HealthDay News — Patient-reported experiences at dialysis facilities vary by patient, facility, and geographic characteristics, according to a study published online September 10 in JAMA Internal Medicine.

Brian M. Brady, MD, from Stanford University in California, and colleagues linked results from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) patient survey to dialysis facility scores for patients in a national end-stage renal disease registry receiving in-center hemodialysis in the United States on December 31, 2014.

Based on 2939 facilities, the researchers found that adjusted mean ICH CAHPS scores were 2.6 percentage points lower in for-profit facilities (95% confidence interval [CI], 1.5 to 3.7), 1.6 percentage points lower in facilities owned by large dialysis organizations (95% CI, 0.9 to 2.2), and 2.3 percentage points lower in free-standing facilities (95% CI, 0.5 to 4.2), compared with their counterparts. Higher scores were associated with more nurses per patient (0.2 percentage points; 95% CI, 0.03 to 0.3) and a privately insured patient population (1.2 percentage points; 95% CI, 0.2 to 2.2). Lower facility scores were associated with facilities with higher proportions of black patients (0.95 percentage points; 95% CI, 0.78 to 1.12) and more Native-American patients (1.00 percentage point; 95% CI, 0.39 to 1.60). Larger proportions of the overall between-facility variation in ICH-CAHPS scores were explained by geographic location and dialysis facility characteristics than patient characteristics. 

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"The perceived quality of dialysis care delivered in certain settings appears to be of concern, and opportunities appear to exist for improved implementation of patient experience surveys in dialysis pay-for-performance programs," the authors write.

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