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Abstract: PO1143

Associations of Dialysis Facility Clinical Performance with Patient Outcomes in the Medicare ESRD Quality Incentive Program (QIP)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Jin, Yan, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Wang, Dongyu, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Kapke, Alissa, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Houseal, Delia, Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
  • Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

In CY2017, CMS implemented the Meaningful Measures Initiative, which aimed to reduce data reporting burden and costs for health care providers and to focus improvement efforts on the most meaningful outcomes for patients. To assure the ESRD QIP is aligned with this initiative and is achieving CMS goals, we assessed whether facility clinical measure performance is associated with improved patient outcomes.

Methods

Patient outcomes at the facility level were evaluated using the CY17 standardized mortality ratio (SMR) and standardized hospitalization ratio (SHR) from Dialysis Facility Compare, and the ESRD QIP CY17 In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) scores. Facility-level performance in CY17 on ESRD QIP measures for hypercalcemia, fistula, long-term catheter, comprehensive Kt/V, NHSN bloodstream infection (BSI) standardized infection ratio (SIR), and standardized transfusion ratio (STrR) was assessed using tertiles. Associations between facility measure performance and outcomes were tested using Poisson models for SMR and SHR and Analysis of Variance (ANOVA) models for ICH-CAHPS scores.

Results

For all ESRD QIP clinical measures, lower levels of performance were associated with higher relative risks (RR) for SMR and SHR (p<.05; Table). For all clinical measures except STrR and NHSN BSI SIR, lower levels of performance were also associated with lower ICH-CAHPS QIP scores (p<.05; Table).

Conclusion

The observed associations of facility performance on individual ESRD QIP clinical measures with mortality, hospitalization, and patient experience with care indicate that the program is incentivizing improvements in care that are related to important patient outcomes.

Funding

  • Other U.S. Government Support