Effect of the ownership of dialysis facilities on patients' survival and referral for transplantation.

@article{Garg1999EffectOT,
  title={Effect of the ownership of dialysis facilities on patients' survival and referral for transplantation.},
  author={Pushkal P. Garg and Kevin D. Frick and Marie Diener-West and Neil R. Powe},
  journal={The New England journal of medicine},
  year={1999},
  volume={341 22},
  pages={
          1653-60
        }
}
BACKGROUND More than 200,000 patients with end-stage renal disease undergo dialysis in the United States each year, about two thirds in for-profit centers. Economic pressures, such as the decline in inflation-adjusted Medicare payments for dialysis, may compromise the quality of care. Facilities may also be reluctant to refer patients to be evaluated for transplantation because of the loss of revenues from dialysis after patients receive transplants. It is unknown whether for-profit facilities… 

Figures and Tables from this paper

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

TLDR
Hemodialysis patients 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% confidence interval, 11% to 20%) higher Rate of Hospitalization for vascular access complications.

Impact of facility size and profit status on intermediate outcomes in chronic dialysis patients.

TLDR
There were few substantial differences in intermediate outcomes in chronic dialysis patients based on facility size or profit status and there were no significant differences in patient demographics based on Facility size.

Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US.

TLDR
Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time for kidney transplant.

Comparative mortality of hemodialysis patients at for-profit and not-for-profit dialysis facilities in the United States, 1998 to 2003: A retrospective analysis

TLDR
While hemodialysis treatment at for-profit and not-for-profit dialysis facilities is associated with different patterns of clinical benchmark achievement, mortality rates are similar.

Reexploring differences among for-profit and nonprofit dialysis providers.

TLDR
hospital days per patient-year were statistically and clinically significantly lower among nonprofit dialysis providers, suggesting that the indirect incentives in Medicare's current payment system may provide insufficient incentive for for-profit providers to achieve optimal patient outcomes.

Referral for Kidney Transplantation in Canadian Provinces.

TLDR
Standardization of transplantation referral practices and ongoing national reporting of referral may decrease disparities in patient access to kidney transplant.

Association Between Dialysis Facility Ownership and Access to Kidney Transplantation.

TLDR
Among US patients with end-stage kidney disease, receiving dialysis at for-profit facilities compared with nonprofit facilities was associated with a lower likelihood of accessing kidney transplantation.

The effect of dialysis chains on mortality among patients receiving hemodialysis.

TLDR
Large chain affiliation is an independent risk factor for ESRD mortality in the United States and reasons behind the increase in mortality require scrutiny.

Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS).

TLDR
DOPPS I and II confirmed large variations in kidney transplantation rates by country, even after adjusting for differences in case mix, and consistently showed higher transplants for younger, healthier, better-educated, and higher income patients.

Factors That Influence Access to the National Renal Transplant Waiting List

TLDR
Differences in listing practice exist between centers that cannot be explained by the patient case mix or center characteristics examined, and whether highlighting these anomalies can influence practice is discovered.
...

References

SHOWING 1-10 OF 36 REFERENCES

Effect of transplantation on the Medicare end-stage renal disease program.

  • P. Eggers
  • Medicine
    The New England journal of medicine
  • 1988
TLDR
In the past decade, the number of kidney transplantations has increased substantially, and the success rate of these procedures has improved, and renal transplantation is causing a convergence of the best clinical and economic outcomes for patients with end-stage renal disease.

Access to kidney transplantation. Has the United States eliminated income and racial differences?

TLDR
White, male, young, nondiabetic, high-income patients treated in smaller units are more likely to receive a cadaver transplant under Medicare than are other kidney patients and profit status of the dialysis unit was not found to be correlated to access to transplantation.

The Ownership of Health Facilities and Clinical Decisionmaking: The Case of the ESRD Industry

TLDR
Patients at for-profit facilities were more likely to be dialyzed in the center and less likely to receive kidney transplants, home dialysis, or peritoneal dialysis than were their counterparts in nonprofit and public facilities.

The Relationship of Provider Organizational Status and Erythropoietin Dosing in End Stage Renal Disease Patients

TLDR
With fixed payment per dose of EPO, for-profit, freestanding providers prescribed EPO more often and administered smaller doses than not-for-profit or government providers, behavior that is consistent with profit maximization.

Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients.

TLDR
The overall mortality risk following renal transplantation was initially increased, but there was a long-term survival benefit compared with similar patients on dialysis.

Dialysis Modality Selection Among Patients Attending Freestanding Dialysis Facilities

  • M. Kendix
  • Medicine, Biology
    Health care financing review
  • 1997
TLDR
An individual-level analysis showed that CAPD, CCPD, and home hemodialysis were more likely to be selected by patients who were younger, had non-systemic precipitating causes of ESRD, had a shorter duration of E SRD, attended larger facilities, and were not ethnic minorities.

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs.

TLDR
Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs, but current efforts to increase dose of dialysis may require higher payments.

The impact of comorbid and sociodemographic factors on access to renal transplantation.

TLDR
Findings indicate that sociodemographics have strong independent effects on access to transplantation that cannot be explained away as "surrogate" effects related to comorbid factors.

Price of dialysis, unit staffing, and length of dialysis treatments.

Mortality and duration of hemodialysis treatment.

TLDR
It is concluded that duration of the dialysis procedure is an important element in determining patient mortality as one of the factors determining the adequacy of dialysis.