By creator to www.healio.com
November 18, 2021
2 min learn
Wang V, et al. Affect of Medicare bundled dialysis fee on regional racial disparities in house dialysis utilization. Offered at: ASN Kidney Week; Nov. 4-7, 2021 (digital assembly).
Wang experiences funding from the Nationwide Committee for High quality Help, the CMS Workplace of Minority Well being and the Division of Veterans Affairs Well being Providers Analysis and Growth.
Following the 2011 Medicare potential fee reform for dialysis companies, racial disparities have endured amongst sufferers utilizing house dialysis within the U.S., in keeping with a speaker at ASN Kidney Week.
“Prior analysis has additionally proven racial disparities in house dialysis, with decrease use amongst black sufferers in comparison with white sufferers with kidney failure. The 2011 Medicare prospective payment reform for dialysis companies modestly elevated entry to house dialysis remedy by means of each service availability by suppliers and affected person utilization. However what stays unclear is whether or not these modifications affected racial disparities in house dialysis use,” Virginia Wang, PhD, affiliate professor within the division of inhabitants well being sciences at Duke College College of Drugs, mentioned. “Our examine aims had been to look at regional tendencies in house dialysis use in 2006 via 2016, amongst whites and non-whites.”
In a retrospective cohort examine, researchers investigated dialysis amenities offering house dialysis to 1,098,579 sufferers with end-stage kidney illness between 2006 and 2016 within the U.S. Every well being care area was outlined as hospital referral areas (HRR), and “non-white” sufferers had been outlined as non-Hispanic Black/African American, Hispanic, non-Hispanic Asian or Pacific Islander, or different race/ethnicity.
To match regional change in dialysis use by affected person race, researchers divided counts of house dialysis customers by white customers of any dialysis modality, then repeated the method to judge charges for the comparability racial teams. These charges had been then in contrast utilizing a generalized estimating equation mannequin with a unfavourable binominal distribution, adjusting for regional ESKD supplier and affected person attribute.
Analyses revealed the imply variety of amenities offering house dialysis in every HRR rose from 15.6 in 2006 to 22.1 in 2016, with for-profit possession (79.8% in 2006 and 87.1% in 2016) and chain affiliation (82.3% in 2006 and 91.7% in 2016) growing over time. Researchers noticed a rise in common regional house dialysis utilization charges over time, but in addition discovered white sufferers skilled persistently increased house dialysis use than sufferers within the racial comparability teams annually (19.5% vs. 12.9% in 2006, 26.2% vs. 17.8% in 2016, on common throughout HRRs).
“Racial disparities and regional house dialysis use didn’t change over time. Nonetheless, house dialysis use remained a 3rd decrease amongst non-whites earlier than and after the 2011 fee reform for dialysis. Modest fee reforms don’t seem like enough levers to cut back historic well being care disparities in house dialysis remedy. However one other optimistic view is that racial disparities didn’t worsen,” Wang mentioned. “Extra direct coverage modifications in American kidney care may help scale back racial disparities in house dialysis use and the info introduced right here could function a helpful benchmark to watch these future modifications.”
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