Abstract: FR-PO868

Does Experience Matter? Nephrology Provider Experience and Patient Outcomes

Session Information

Category: Dialysis

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

Authors

  • Reule, Scott, University of Minnesota, Minneapolis, Minnesota, United States
  • Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States
  • Drawz, Paul E., University of Minnesota, Minneapolis, Minnesota, United States
  • Ishani, Areef, None, Minneapolis, Minnesota, United States
  • Rosenberg, Mark E., University of Minnesota, Minneapolis, Minnesota, United States
Background

Provider experience is associated with patient outcomes in select surgical settings. Similar associations have not demonstrated in other fields including nephrology, a field tasked with the care of patients with multimorbidity.

Methods

Using physician data within the AMA Masterfile combined with patient and Medicare claims data from the USRDS limited to the years 2010-2012, we determined associations between experience and survival after initiation of renal replacement therapy.

Results

We identified 360,787 patients on renal replacement therapy cared for by 7,535 providers. A total of 38,889 patients received care from 1,412 providers with 0-8 years of experience; 178,802 patients received care from 3,615 providers with 9-21 years of experience; and 129,855 patients received care from 2,508 providers with > 21 years of experience. Compared to both those with 9-21 and > 21 years of experience, providers with 0-8 years were more likely to be female (34.1% vs. 27.1% with 9-21 yrs.; 34.1% vs. 16.1% with > 21 yrs.) practice in the Midwest region of the US (20.8% vs. 18.9% with 9-21yrs.; 20.8% vs. 17.9%, with > 21 yrs.), and have graduated from an osteopathic training program (6.6% vs. 4.8%; with 9-21 yrs.; 6.6% vs. 2.2%, > 21 yrs.). No significant patient level characteristics were associated with provider experience. Overall, 31.4% of the cohort died at a mean of 5.8 years. Increased provider experience was associated with lower HR of death (AHR 0.95, 9-21 years; AHR 0.96, > 21 yrs. vs. 0-8 yrs.) adjusted for provider and patient level variables. One-year survival after initiation of renal replacement therapy was lowest for those receiving care from those with 0-8 years of experience (Log rank, P < 0.001).

Conclusion

In our limited sample, increasing provider experience is associated with decreased patient mortality on renal replacement therapy providing evidence that experience does matter.