Abstract: PO0791
Disparities in Quality of Care for Dialysis Patients
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
- Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Cogan, Chad M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Huff, Edwin D., Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
Background
An understanding of disparities in quality of care for dialysis patients may inform priorities for quality improvement and approaches for achieving greater health equity. It is also not known whether disparities have been improving or worsening or whether they vary geographically.
Methods
We used Medicare claims and CROWNWeb data to evaluate disparities based on race, ethnicity, dual eligibility, and rural-urban location. Using criteria developed by AHRQ, we identified disparities in 2019 based on a statistically significant regression-adjusted difference in a quality indicator and at least a 10% relative difference between groups. We estimated generalized linear models with clustering for patients and adjustments for age, sex, cause of ESRD, duration of ESRD, and comorbid conditions at ESRD incidence. We examined national trends in disparities from 2015-20 and variation in disparities by ESRD Network in 2019.
Results
There is evidence of disparities in U.S. dialysis patients for a range of quality indicators in 2019 (Table), some of which relate to measures in the ESRD Quality Incentive Program. Disparities involving racial minorities and dual eligible beneficiaries accounted for 13 of 16 measured disparities nationally. These disparities largely persisted over time and were found in most ESRD Networks.
Conclusion
There are ongoing racial, socioeconomic, and rural-urban disparities among dialysis patients in a range of quality indicators. There may be valuable opportunities for quality initiatives in ESRD to improve health equity.
| Quality Indicator | Comparison | Disparity Group | Reference Group | Difference (disparity group vs. reference group) | Adjusted difference (all p<0.001) | Relative difference, as % of reference group |
| AV Fistula (% of patients) | Black vs white | 57.6% | 67.0% | -9.4 | -8.6 | -12.8% |
| Long-term Catheter Use (% of patients) | Dual vs not dual | 11.6% | 10.0% | 1.6 | 1.3 | 13.0% |
| All-Cause Hospital Admissions (per 100 patient-months) | Dual vs not dual | 16.1 | 12.9 | 3.2 | 2.1 | 16.0% |
| 30-day Hospital Readmissions (% of index discharges) | Dual vs not dual | 30.6% | 25.5% | 5.2 | 3.4 | 13.4% |
| Dialysis Access-related Infection Hospital Admissions (per 100 patient-months) | Dual vs not dual | 0.8 | 0.6 | 0.2 | 0.1 | 17.5% |
| Outpatient Emergency Department (OP ED) Visits (per 100 patient-months) | Dual vs not dual | 18.6 | 12.0 | 6.6 | 4.4 | 36.9% |
| OP ED Visits (per 100 patient-months) | Black vs white | 17.0 | 14.9 | 2.1 | 1.5 | 10.0% |
| OP ED Visits (per 100 patient-months) | Rural vs urban | 20.9 | 14.7 | 6.2 | 5.4 | 36.6% |
| Hemoglobin <10 g/dL (% of patients) | Black vs white | 26.5% | 23.6% | 2.9 | 3.2 | 13.5% |
| Part D Opioid Long Term Use (% of patients) | Dual vs not dual | 11.1% | 5.9% | 5.2 | 1.8 | 31.1% |
| Part D Opioid Long Term Use (% of patients) | Rural vs urban | 11.6% | 8.7% | 2.8 | 1.8 | 20.8% |
| Mortality (per 100 patient-months) | Rural vs urban | 1.7 | 1.4 | 0.3 | 0.2 | 12.0% |
| Hospice Use at Death (% of patients) | Asian vs white | 19.0% | 31.6% | -12.6 | -13.9 | -43.9% |
| Hospice Use at Death (% of patients) | Amer. Indian/Alaska Native vs white | 19.6% | 31.6% | -12.0 | -7.1 | -22.3% |
| Hospice Use at Death (% of patients) | Black vs white | 20.2% | 31.6% | -11.4 | -8.3 | -26.3% |
| Hospice Use at Death (% of patients) | Pacific Isl. vs white | 17.0% | 31.6% | -14.6 | -11.4 | -35.9% |
Funding
- Other U.S. Government Support