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- Title
Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study.
- Authors
Thorsteinsdottir, Bjorg; Ramar, Priya; Hickson, LaTonya J.; Reinalda, Megan S.; Albright, Robert C.; Tilburt, Jon C.; Williams, Amy W.; Takahashi, Paul Y.; Jeffery, Molly M.; Shah, Nilay D.
- Abstract
<bold>Background: </bold>Efficient and safe delivery of care to dialysis patients is essential. Concerns have been raised regarding the ability of accountable care organizations to adequately serve this high-risk population. Little is known about primary care involvement in the care of dialysis patients. This study sought to describe the extent of primary care provider (PCP) involvement in the care of hemodialysis patients and the outcomes associated with that involvement.<bold>Methods: </bold>In a retrospective cohort study, patients accessing a Midwestern dialysis network from 2001 to 2010 linked to United States Renal Database System and with >90 days follow up were identified (n = 2985). Outpatient visits were identified using Current Procedural Terminology (CPT)-4 codes, provider specialty, and grouped into quartiles-based on proportion of PCP visits per person-year (ppy). Top and bottom quartiles represented patients with high primary care (HPC) or low primary care (LPC), respectively. Patient characteristics and health care utilization were measured and compared across patient groups.<bold>Results: </bold>Dialysis patients had an overall average of 4.5 PCP visits ppy, ranging from 0.6 in the LPC group to 6.9 in the HPC group. HPC patients were more likely female (43.4% vs. 35.3%), older (64.0 yrs. vs. 60.0 yrs), and with more comorbidities (Charlson 7.0 vs 6.0). HPC patients had higher utilization (hospitalizations 2.2 vs. 1.8 ppy; emergency department visits 1.6 vs 1.2 ppy) and worse survival (3.9 vs 4.3 yrs) and transplant rates (16.3 vs. 31.5).<bold>Conclusions: </bold>PCPs are significantly involved in the care of hemodialysis patients. Patients with HPC are older, sicker, and utilize more resources than those managed primarily by nephrologists. After adjusting for confounders, there is no difference in outcomes between the groups. Further studies are needed to better understand whether there is causal impact of primary care involvement on patient survival.
- Subjects
MIDWEST (U.S.); UNITED States; HEMODIALYSIS; HEMODIALYSIS patients; PRIMARY care; CHRONIC kidney failure; TREATMENT of chronic kidney failure; LONGITUDINAL method; MEDICAL care; MEDICAL care use; PATIENTS; PRIMARY health care; RESEARCH funding; RETROSPECTIVE studies; PATIENTS' attitudes
- Publication
BMC Nephrology, 2017, Vol 18, p1
- ISSN
1471-2369
- Publication type
journal article
- DOI
10.1186/s12882-017-0728-x