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Abstract: TH-PO277

In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) Survey Response and Long-Term Clinical Outcomes

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Dad, Taimur, Tufts Medical Center, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Grobert, Megan, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Lacson, Eduardo K., Tufts Medical Center, Boston, Massachusetts, United States
  • Meyer, Klemens B., Tufts Medical Center, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Richardson, Michelle M., New England Medical Center, Boston, Massachusetts, United States
Background

The In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey, introduced into the ESRD Quality Incentive Program, is the only patient-reported outcome measure currently used for value-based reimbursement in dialysis. It is administered twice yearly to assess hemodialysis patient experience. Current response rates are approximately 30%. The relationship between response status and long-term clinical outcomes is unknown.

Methods

All Dialysis Clinic Inc. (DCI) hemodialysis patients age 18 and older treated at their facility for at least 3 months as of August 2012 were eligible for the survey. Covariates included patient demographic, clinical, and treatment related characteristics. Outcomes included mortality, kidney transplantation, and all cause-hospitalization.

Results

Among 10,395 eligible patients who survived the 3-month survey administration, 3,794 (36%) responded to the survey. Over median follow-up of 30 months, 4,178 patients died, 5,336 patients were hospitalized at least once, and 717 patients received a transplant. In multivariable models, survey response was associated with lower mortality (HR 0.80; 95% CI: 0.74-0.85) and hospitalization (HR 0.84; CI: 0.79-0.89) and higher likelihood for kidney transplant (HR 1.15; 95% CI: 0.98-1.35). Sensitivity analyses evaluating the receipt of transplant with competing risk for death, or a composite outcome of death or hospitalization, yielded similar results.

Conclusion

Response to the ICH CAHPS survey is associated with a lower risk for mortality and hospitalization and higher likelihood for kidney transplantation. These findings raise concern about survey result generalizability and use for quality improvement since experiences of high-risk patients are less likely to be captured.

Funding

  • Other NIH Support