Patients report poorer dialysis service in certain settings

(HealthDay)—Patient-reported experiences at dialysis facilities vary by patient, facility, and geographic characteristics, according to a study published online Sept. 10 in JAMA Internal Medicine.

Brian M. Brady, M.D., from Stanford University in California, and colleagues linked results from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) patient survey to dialysis facility scores for patients in a national end-stage renal disease registry receiving in-center hemodialysis in the United States on Dec. 31, 2014.

Based on 2,939 facilities, the researchers found that adjusted mean ICH CAHPS scores were 2.6 percentage points lower in for-profit facilities (95 percent confidence interval [CI], 1.5 to 3.7), 1.6 percentage points lower in facilities owned by large dialysis organizations (95 percent CI, 0.9 to 2.2), and 2.3 percentage points lower in free-standing facilities (95 percent CI, 0.5 to 4.2), compared with their counterparts. Higher scores were associated with more nurses per patient (0.2 percentage points; 95 percent CI, 0.03 to 0.3) and a privately insured patient population (1.2 percentage points; 95 percent CI, 0.2 to 2.2). Lower facility scores were associated with facilities with higher proportions of black patients (0.95 percentage points; 95 percent CI, 0.78 to 1.12) and more Native-American patients (1.00 percentage point; 95 percent CI, 0.39 to 1.60). Larger proportions of the overall between-facility variation in ICH-CAHPS scores were explained by geographic location and dialysis facility characteristics than patient characteristics.

"The perceived quality of dialysis care delivered in certain settings appears to be of concern, and opportunities appear to exist for improved implementation of patient experience surveys in dialysis pay-for-performance programs," the authors write.

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