Abstract: PO0794
Racial Disparities in Staff CPR Performance Within US Dialysis Clinics: The Role of Clinic Resources and Patient Factors
Session Information
- Dialysis Care: Epidemiology and the Patient Experience
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Pun, Patrick H., Duke Clinical Research Institute, Durham, North Carolina, United States
- Dupre, Matthew, Duke Clinical Research Institute, Durham, North Carolina, United States
Background
Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate CPR provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compared to White patients. We examined the contribution of dialysis facility resources and patient factors to the observed racial disparity in CPR.
Methods
Retrospective cohort study linking the National Cardiac Arrest Registry to Enhance Survival (CARES) and Medicare Annual Dialysis Facility Report registries. We identified cardiac arrests occurring within US outpatient dialysis clinics via geolocation matching. Differences in facility size, quality, staffing and patient related factors were summarized and compared according to patient race. Multilevel multivariable logistic regression models including these factors were constructed to examine the influence of these factors on the observed disparity in CPR rates between Black and White patients.
Results
From 2013-2017, we identified 1,554 patients experiencing cardiac arrest in dialysis clinics. Compared to White patients, Black cardiac arrest patients dialyzed in larger facilities (26 vs 21 dialysis stations, p<0.001), facilities with less RNs per station (0.29 vs 0.33, p<0.001), and facilities with lower quality scores (# citations 6.8 vs 6.3, p=0.04). Facilities treating Black patients cared for a higher proportion of patients with a history of cardiac arrest (41 vs 35%, p<0.001), HIV/Hepatitis B (5.1% vs 2.9%, p<0.001) and Medicaid enrolled patients (15% vs 11%, p<0.001). After accounting for these differences and other covariates, there was no change in the racial disparity for CPR in Black vs. White patients (OR=0.45 (95% CI 0.27-0.75). The disparity was greater among older Black patients compared to younger patients (interaction p=0.04). Other patient related and facility quality-related factors did not moderate the racial disparity in receipt of CPR.
Conclusion
The racial disparity in CPR delivery within dialysis clinics cannot be explained by differences in facility resources and quality. Reducing this disparity will require a multi-faceted approach including developing dialysis clinic-specific protocols for CPR and addressing potential implicit bias.
Funding
- NIDDK Support