What is the Best Setting for Receiving Dialysis Vascular access Repair and Maintenance Services?

Autor: Brook Cowin, Gerald A. Beathard, Al Dobson, Audrey M. El-Gamil, Nikolay Manolov, Joan E DaVanzo, Terry Litchfield
Rok vydání: 2017
Předmět:
Male
Catheterization
Central Venous
medicine.medical_specialty
Outpatient Clinics
Hospital
Time Factors
Databases
Factual
Office Visits
Cost-Benefit Analysis
medicine.medical_treatment
030232 urology & nephrology
Vascular access
MEDLINE
Medicare
Ambulatory Care Facilities
Blood Vessel Prosthesis Implantation
03 medical and health sciences
Arteriovenous Shunt
Surgical
Patient Admission
Postoperative Complications
0302 clinical medicine
Renal Dialysis
Health care
medicine
Humans
Vascular Patency
Outpatient clinic
030212 general & internal medicine
Healthcare Disparities
Hospital Costs
Intensive care medicine
Dialysis
Retrospective Studies
Cost–benefit analysis
Delivery of Health Care
Integrated
business.industry
Retrospective cohort study
Middle Aged
United States
Treatment Outcome
Nephrology
Centralized Hospital Services
Female
Surgery
business
Administrative Claims
Healthcare
Zdroj: The Journal of Vascular Access. 18:473-481
ISSN: 1724-6032
1129-7298
DOI: 10.5301/jva.5000790
Popis: Introduction Advances in dialysis vascular access (DVA) management have changed where beneficiaries receive this care. The effectiveness, safety, quality, and economy of different care settings have been questioned. This study compares patient outcomes of receiving DVA services in the freestanding office-based center (FOC) to those of the hospital outpatient department (HOPD). It also examines whether outcomes differ for a centrally managed system of FOCs (CMFOC) compared to all other FOCs (AOFOC). Methods Retrospective cohort study of clinically and demographically similar patients within Medicare claims available through United States Renal Data System (USRDS) (2010-2013) who received at least 80% of DVA services in an FOC (n = 80,831) or HOPD (n = 133,965). Separately, FOC population is divided into CMFOC (n = 20,802) and AOFOC (n = 80,267). Propensity matching was used to control for clinical, demographic, and functional characteristics across populations. Results FOC patients experienced significantly better outcomes, including lower annual mortality (14.6% vs. 17.2%, pConclusions Where nephrologists send patients for DVA services can impact patient clinical and economic outcomes. This research confirmed that patients who received DVA care in the FOC had better outcomes than those treated in the HOPD. The organizational culture and clinical oversight of the CMFOC may result in more favorable outcomes than receiving care in AOFOC.
Databáze: OpenAIRE
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