Abstract: FR-PO865
Nephrologist Preferences Exacerbate Disparities in Access to High Quality Dialysis Facilities
Session Information
- Diversity and Equity in Kidney Health - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
Authors
- Lin, Eugene, University of Southern California Keck School of Medicine, Los Angeles, California, United States
- Lung, Khristina I., University of Southern California, Los Angeles, California, United States
- Van Nuys, Karen, University of Southern California, Los Angeles, California, United States
Background
Ideally, patients initiating outpatient dialysis for end-stage kidney disease are referred to higher quality facilities closer to their residence. However, nephrologists might refer patients to “preferred facilities,” even if lower quality or distant. We investigated whether patients were more likely referred to nephrologists’ preferred facilities and racial differences in referrals.
Methods
For adults with fee-for-service Medicare initiating dialysis from 2016-2018, we identified the nephrologist’s “preferred facility” or the facility with the plurality of the nephrologist’s patients. For the patient’s first facility and the nephrologist’s preferred facility, we determined the quality (using Medicare’s published Five-Star ratings, a score based on Medicare quality measures) and distance to the patient. Since quality differs by region, we define a high-quality facility as the top quartile of facilities within a referral area (i.e., the highest quality available to the patient).
Results
Unadjusted, patients had a 19% probability of dialyzing at their nephrologist’s preferred facility if it was distant but a 65% probability if low-quality/close and a 74% probability if high-quality/close. In multivariable analysis, patients were more likely to dialyze at preferred facilities if close. Relative to when the preferred facility was low-quality/distant, patients were more likely to dialyze at preferred facilities that were low-quality/close (OR: 8.1, 95% CI: 7.7, 8.4) and high-quality/close (OR: 11.6, 95% CI: 11.0, 12.3). When preferred facilities were low-quality/close, patients were more likely to dialyze at low-quality facilities (OR: 3.2, 95% CI: 3.0, 3.4), and when high-quality/close, patients were more likely to dialyze at high-quality facilities (OR: 3.8, 95% CI: 3.5, 4.1). Relative to White patients, Black patients were less likely to have nephrologists with high-quality preferred facilities (OR: 0.93, 95% CI: 0.88, 0.97) and were less likely to dialyze at high-quality facilities (OR: 0.88, 95% CI: 0.84, 0.92).
Conclusion
Patients more likely dialyzed at nephrologists' preferred facilities when close. Patients thus opt for low-quality facilities if their nephrologist prefers a low-quality facility. Because Black patients more likely had nephrologists preferring low-quality facilities, they more likely dialyzed at the lowest-quality facilities available.
Funding
- NIDDK Support