Abstract: FR-PO871

Comparative Effectiveness of Dialysis for Veterans in VA and Non-VA Settings

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Wang, Virginia, Durham VAMC, Durham, North Carolina, United States
  • Coffman, Cynthia, Durham VAMC, Durham, North Carolina, United States
  • Stechuchak, Karen M., Durham VAMC, Durham, North Carolina, United States
  • Hebert, Paul L., VA Puget Sound Health Care System, Seattle, Washington, United States
  • O'Hare, Ann M., VA Puget Sound Health Care System, Seattle, Washington, United States
  • Edelman, David, Durham VAMC, Durham, North Carolina, United States
  • Weidenbacher, Hollis J, Durham VAMC, Durham, North Carolina, United States
  • Maciejewski, Matthew L., Durham VAMC, Durham, North Carolina, United States
Background

Veterans with ESRD have different options for obtaining dialysis including: Medicare-funded community dialysis; VA in-house; and VA-purchased community dialysis (VA-PC). Differences in outcomes across these settings may reflect differences in patient characteristics or quality of care and care coordination, or both. This study compares hospitalization rates and days of care between Veterans receiving outpatient dialysis in VA, VA-PC, and Medicare settings.

Methods

We used VA and Medicare administrative data to construct a national cohort of VA-enrolled Veterans who initiated maintenance dialysis in 2008-2011. Cohort members were classified based on dialysis setting during the 2-year period immediately following dialysis initiation: 1) VA dialysis (VA); 2) VA-PC in non-VA dialysis units; 3) Medicare-financed dialysis in non-VA units (Medicare); or 4) “Mixed”. We used logistic and negative binomial regression models to examine the associations between dialysis setting and hospitalization and hospital days (respectively) within 2-years after dialysis initiation (censoring at renal transplant or death), adjusting for patient demographic and clinical characteristics.

Results

Of the 27,301 cohort members, 67% received dialysis outside the VA under Medicare, 11% received dialysis outside the VA through VA-PC, 4% were treated in VA facilities, and 18% were treated in two or more of these settings (Table 1). Most Veterans were hospitalized (83%) and spent an average of 22.7 days in the hospital (median=14, IQR=8) during follow-up. Only Veterans receiving dialysis in two or more settings had higher rates of hospitalization versus those receiving dialysis under Medicare (OR= 1.3; 95% CI= 1.1, 1.5). There were no differences between groups in length of stay (p=0.26).

Conclusion

Veterans who received dialysis in more than one setting were at increased risk for hospitalization during the first two years after dialysis initiation.

Funding

  • Veterans Affairs Support