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Abstract: PO0791

Disparities in Quality of Care for Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Cogan, Chad M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Huff, Edwin D., Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
Background

An understanding of disparities in quality of care for dialysis patients may inform priorities for quality improvement and approaches for achieving greater health equity. It is also not known whether disparities have been improving or worsening or whether they vary geographically.

Methods

We used Medicare claims and CROWNWeb data to evaluate disparities based on race, ethnicity, dual eligibility, and rural-urban location. Using criteria developed by AHRQ, we identified disparities in 2019 based on a statistically significant regression-adjusted difference in a quality indicator and at least a 10% relative difference between groups. We estimated generalized linear models with clustering for patients and adjustments for age, sex, cause of ESRD, duration of ESRD, and comorbid conditions at ESRD incidence. We examined national trends in disparities from 2015-20 and variation in disparities by ESRD Network in 2019.

Results

There is evidence of disparities in U.S. dialysis patients for a range of quality indicators in 2019 (Table), some of which relate to measures in the ESRD Quality Incentive Program. Disparities involving racial minorities and dual eligible beneficiaries accounted for 13 of 16 measured disparities nationally. These disparities largely persisted over time and were found in most ESRD Networks.

Conclusion

There are ongoing racial, socioeconomic, and rural-urban disparities among dialysis patients in a range of quality indicators. There may be valuable opportunities for quality initiatives in ESRD to improve health equity.

Quality IndicatorComparisonDisparity GroupReference GroupDifference (disparity group vs. reference group)Adjusted difference (all p<0.001)Relative difference, as % of reference group
AV Fistula (% of patients)Black vs white57.6%67.0%-9.4-8.6-12.8%
Long-term Catheter Use (% of patients)Dual vs not dual11.6%10.0%1.61.313.0%
All-Cause Hospital Admissions (per 100 patient-months)Dual vs not dual16.112.93.22.116.0%
30-day Hospital Readmissions (% of index discharges)Dual vs not dual30.6%25.5%5.23.413.4%
Dialysis Access-related Infection Hospital Admissions (per 100 patient-months)Dual vs not dual0.80.60.20.117.5%
Outpatient Emergency Department (OP ED) Visits (per 100 patient-months)Dual vs not dual18.612.06.64.436.9%
OP ED Visits (per 100 patient-months)Black vs white17.014.92.11.510.0%
OP ED Visits (per 100 patient-months)Rural vs urban20.914.76.25.436.6%
Hemoglobin <10 g/dL (% of patients)Black vs white26.5%23.6%2.93.213.5%
Part D Opioid Long Term Use (% of patients)Dual vs not dual11.1%5.9%5.21.831.1%
Part D Opioid Long Term Use (% of patients)Rural vs urban11.6%8.7%2.81.820.8%
Mortality (per 100 patient-months)Rural vs urban1.71.40.30.212.0%
Hospice Use at Death (% of patients)Asian vs white19.0%31.6%-12.6-13.9-43.9%
Hospice Use at Death (% of patients)Amer. Indian/Alaska Native vs white19.6%31.6%-12.0-7.1-22.3%
Hospice Use at Death (% of patients)Black vs white20.2%31.6%-11.4-8.3-26.3%
Hospice Use at Death (% of patients)Pacific Isl. vs white17.0%31.6%-14.6-11.4-35.9%

Funding

  • Other U.S. Government Support