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Kidney Week

Abstract: TH-OR45

Higher Patient-to-Patient Care Technician Ratios Associated with Worse Outcomes Among US In-Center Hemodialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Plantinga, Laura, Emory University, Atlanta, Georgia, United States
  • Bender, Alexis A., Emory University, Atlanta, Georgia, United States
  • Urbanski, Megan, Emory University, Atlanta, Georgia, United States
  • Hoge, Courtney E., Emory University, Atlanta, Georgia, United States
  • Morgan, Jennifer Craft, Georgia State University, Atlanta, Georgia, United States
  • Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
Background

It is increasingly difficult to maintain adequate dialysis patient care technician (PCT) staffing at U.S. in-center hemodialysis (ICHD) facilities. We aimed to explore the associations of ICHD patient outcomes with facility-level PCT staffing.

Methods

U.S. patients (ages 18-100) initiating ICHD between 1/1/16 and 12/31/18 were included if they remained on ICHD for ≥90 days and had data on PCT staffing at their ICHD facility (N=236,126; mean age, 63.1; 57.6% male; 27.9% Black; 61.8% with diabetes; 60.2% starting ICHD with a catheter only). We estimated the association of time to 1-year patient outcomes with facility-level PCT staffing (=quartiles of patient:PCT ratios) using mixed-effects Poisson regression, with censoring as appropriate and adjustment for age, sex, race, pre-end-stage kidney disease nephrology care, diabetes, and first vascular access type.

Results

After adjustment, highest vs. lowest quartile of facility-level patient:PCT ratio was associated with 11%, 10%, and 10% higher rates of patient mortality, hospitalization, and readmission, respectively; associations with rates of waitlisting and transplant were not significant (Figure 1). Highest vs. lowest quartile of patient:PCT ratio was associated with 10%, 13%, and 22% higher rates of fluid overload-, sepsis-, and vascular access-related hospitalizations, respectively (Figure 2).

Conclusion

Patients initiating treatment in facilities with the least adequate PCT staffing may have worse early outcomes. While effects are modest and causal inference is limited, our results support further investigation of the effects of U.S. PCT staffing on patient safety and quality of U.S. ICHD care.

Funding

  • Other U.S. Government Support