دورية أكاديمية
Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model.
| العنوان: | Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model. |
|---|---|
| المؤلفون: | Koukounas KG; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island., Thorsness R; Providence VA Medical Center, Providence, Rhode Island., Patzer RE; Regenstrief Institute, Indianapolis, Indiana.; Department of Surgery, Division of Transplant Surgery, Indiana University School of Medicine, Indianapolis., Wilk AS; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia., Drewry KM; Regenstrief Institute, Indianapolis, Indiana.; Department of Surgery, Division of Transplant Surgery, Indiana University School of Medicine, Indianapolis., Mehrotra R; Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle., Rivera-Hernandez M; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island., Meyers DJ; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island., Kim D; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island., Trivedi AN; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island.; Providence VA Medical Center, Providence, Rhode Island. |
| المصدر: | JAMA [JAMA] 2024 Jan 09; Vol. 331 (2), pp. 124-131. |
| نوع المنشور: | Journal Article; Research Support, N.I.H., Extramural |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago : American Medical Association, 1960- |
| مواضيع طبية MeSH: | Healthcare Disparities*/economics , Healthcare Disparities*/ethnology , Healthcare Disparities*/statistics & numerical data , Kidney Failure, Chronic*/economics , Kidney Failure, Chronic*/epidemiology , Kidney Failure, Chronic*/ethnology , Kidney Failure, Chronic*/therapy , Reimbursement, Incentive*/economics , Reimbursement, Incentive*/statistics & numerical data , Renal Dialysis*/economics , Renal Dialysis*/methods , Renal Dialysis*/statistics & numerical data , Social Determinants of Health*/economics , Social Determinants of Health*/ethnology , Social Determinants of Health*/statistics & numerical data , Self Care*/economics , Self Care*/methods , Self Care*/statistics & numerical data, Aged ; Female ; Humans ; Male ; Black or African American/statistics & numerical data ; Black People/statistics & numerical data ; Cross-Sectional Studies ; Hispanic or Latino/statistics & numerical data ; Kidney Transplantation/statistics & numerical data ; Medicaid/economics ; Medicaid/statistics & numerical data ; Medically Uninsured/statistics & numerical data ; Models, Economic ; United States/epidemiology ; Vulnerable Populations/statistics & numerical data ; Waiting Lists |
| مستخلص: | Importance: The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model. Objective: To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk. Design, Setting, and Participants: A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021. Exposure: Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics. Main Outcomes and Measures: Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization. Results: Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001). Conclusions: In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties. |
| التعليقات: | Comment in: JAMA. 2024 Jan 9;331(2):108-110. (PMID: 38193972) |
| References: | JAMA. 2020 Sep 8;324(10):975-983. (PMID: 32897345) Am J Transplant. 2012 Feb;12(2):358-68. (PMID: 22233181) Kidney Med. 2020 Feb 11;2(2):105-115. (PMID: 32734231) JAMA. 2020 Sep 1;324(9):900-901. (PMID: 32870292) JAMA Health Forum. 2022 Oct 7;3(10):e223503. (PMID: 36206005) J Am Soc Nephrol. 2010 Jul;21(7):1192-9. (PMID: 20558541) J Am Soc Nephrol. 2021 Feb;32(2):265-267. (PMID: 33380524) J Am Soc Nephrol. 2016 Jul;27(7):2123-34. (PMID: 26657565) Health Aff (Millwood). 2014 Aug;33(8):1314-22. (PMID: 25092831) Health Aff (Millwood). 2019 Jul;38(7):1101-1109. (PMID: 31260369) Am J Transplant. 2020 Jan;20(1):190-203. (PMID: 31278832) Health Aff (Millwood). 2016 Jan;35(1):124-31. (PMID: 26733710) J Am Soc Nephrol. 2020 Mar;31(3):625-636. (PMID: 31941721) Semin Dial. 2020 Jan;33(1):43-51. (PMID: 31899828) JAMA Netw Open. 2023 Feb 1;6(2):e230806. (PMID: 36848086) J Am Soc Nephrol. 2020 Feb;31(2):424-433. (PMID: 31857351) JAMA Netw Open. 2022 Oct 3;5(10):e2239139. (PMID: 36306136) J Am Soc Nephrol. 2020 Feb;31(2):238-240. (PMID: 31980589) JAMA. 2023 Mar 14;329(10):810-818. (PMID: 36917063) Health Aff (Millwood). 2021 Jun;40(6):945-950. (PMID: 34097525) Fed Regist. ;82(210):50738-97. (PMID: 29091373) Health Aff (Millwood). 2020 Sep;39(9):1504-1512. (PMID: 32897781) N Engl J Med. 2018 Jun 28;378(26):2456-2458. (PMID: 29949490) JAMA. 2021 Dec 14;326(22):2323-2325. (PMID: 34905040) Ann Intern Med. 2015 Sep 15;163(6):427-36. (PMID: 26343790) J Gen Intern Med. 2018 Apr;33(4):567-569. (PMID: 29302881) JAMA. 2020 Sep 8;324(10):948-950. (PMID: 32897331) Transplantation. 2014 Sep 27;98(6):640-5. (PMID: 24809750) Health Aff (Millwood). 2019 Jul;38(7):1127-1131. (PMID: 31260343) Am J Kidney Dis. 2022 Dec;80(6):707-717. (PMID: 35301050) J Am Soc Nephrol. 2009 Jun;20(6):1333-40. (PMID: 19339381) |
| معلومات مُعتمدة: | R01 MD017080 United States MD NIMHD NIH HHS; R01 DK113298 United States DK NIDDK NIH HHS; K01 DK128384 United States DK NIDDK NIH HHS |
| تواريخ الأحداث: | Date Created: 20240109 Date Completed: 20240114 Latest Revision: 20240114 |
| رمز التحديث: | 20240114 |
| مُعرف محوري في PubMed: | PMC10777251 |
| DOI: | 10.1001/jama.2023.23649 |
| PMID: | 38193961 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1538-3598 |
|---|---|
| DOI: | 10.1001/jama.2023.23649 |