Abstract: FR-PO1034
Effect of the Comprehensive ESRD Care Model on Specialty Palliative Care Use in Patients with ESKD
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Bailoor, Kunal, University of Michigan, Ann Arbor, Michigan, United States
- Vita, Alexandra Julia, University of Michigan, Ann Arbor, Michigan, United States
- Hirth, Richard A., University of Michigan, Ann Arbor, Michigan, United States
- Guro, Paula A., University of Michigan, Ann Arbor, Michigan, United States
- Oerline, Mary K., University of Michigan, Ann Arbor, Michigan, United States
- Shahinian, Vahakn, University of Michigan, Ann Arbor, Michigan, United States
Background
Patients with end stage kidney disease (ESKD) on hemodialysis have major unmet palliative care needs but very low use of specialty palliative care. A shift to increased palliative care use in the ESKD population may offer opportunities for cost savings due to reduced acute care utilization, a goal of recent models of health care delivery. We investigated whether participation in one such model, the Comprehensive ESRD Care (CEC) model, which ran from 2015 to 2021, was associated with increased use of specialty palliative care
Methods
We conducted a nationwide, retrospective cohort study involving 732,207 patients with ESKD dialyzing in 22,259 facilities between 2016 and 2020. Using the Callaway-Sant’Anna difference-in-difference framework for multiple time periods, we compared patients dialyzing in facilities who joined the CEC between 2016 and 2020 to those in never-participating facilities, with co-variates for patient level variables such as age, socioeconomic status, Hierarchical Condition Comorbidities (HCC), a measure of co-morbidities, among others. CEC facilities were matched to control never-participating facilities based on facility characteristics (e.g, number of facility patients, percent on peritoneal dialysis, etc)
Results
The group-time average treatment effect remained around 0 through all examined periods, indicating no significant effect on specialty palliative care use. This was unchanged when examining specifically patients over the age of 75 and in the top quartile of number of HCCs
Conclusion
The CEC model was not associated with an increase in specialty palliative care use for patients with ESKD. Further research into alternative methods to increase specialty palliative care use is required
Graph of group-time average treatment effect measures. Blue bars are difference in likelihood of specialty palliative case use in CEC-joiners compared to never-joiners prior to joining the CEC. Red bars are difference in likelihood of specialty palliative care use in CEC-joiner compared to never-joiners in years after joining
Funding
- NIDDK Support