Patients at Higher-Rated Dialysis Centers More Likely to Get on Kidney Transplant Waitlists

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The dialysis center, the gatekeeper of the waiting list for kidney transplants, is today generating more data and inspiring more policies than ever before. However, existing dialysis facility comparison (DFC) quality metrics for these centers include time to transplant waiting lists that encourage coordination of care across the spectrum of dialysis centers, nephrologists, hospitals, and transplant centers. Long-term metrics are not included. A new study by a team of researchers at Brigham and Women’s Hospital aims to bridge this gap by investigating the potential association between patient, institutional, and waiting list characteristics and the center’s DFC assessment. I was there. By combining data from the US Renal Data System (USRDS) to DFC Center assessments between 2013 and 2018, researchers are 47% more likely to be on the patient’s waiting list at highly rated institutions. I found that.The results are published in JAMA network open..

“Historically, quality measurement programs have focused on specific treatment areas, so our aim was to focus on the patient’s ongoing experience,” said the Brigham Surgical Public Health Center (CSPH). Dr. Thomas Tsai, MD, said. In surgery. “I wanted to know if the current quality measurements reflect the complete continuity of care and if patients receiving care at a higher rated center are likely to be listed for kidney transplantation. rice field.”

Patients with end-stage kidney disease (ESKD) no longer have a viable kidney that effectively filters blood. Therefore, without treatment, dangerous biowaste levels remain in the body. These patients have several treatment options. Dialysis, Kidney transplant Or conservative kidney management. Kidney transplants are often the best option for patients, but to receive a transplant, the patient must be referred by the dialysis center to a national waiting list maintained by the United Network for Organ Sharing (UNOS). .. ESKD diagnosis is life-threatening and further emphasizes the importance of quality intervention after diagnosis. Quality is measured by the Medicare DFC Star System. The Star System describes nine individual health statistics, including death, hospitalization, and blood transfusions, ranks institutions, and obtains a final assessment.


To assess existing quality indicators for dialysis centers, researchers used USRDS data to exclude patients who attended unassessed centers or who had already undergone transplantation, and then 507 out of 6,661 unique facilities. , 581 years of patient experience collected.Researchers can use these data to use patients, institutions, or liver The characteristics of the waiting list for transplantation were associated with the evaluation of the corresponding dialysis center.

By comparing 5-star and 1-star facilities, the team found that these highly rated facilities were associated with a 47% increase in the likelihood of being on the waiting list for transplants. .. In addition, the team found that black patients were less likely to be on the waiting list than white patients and were more likely to be in 1-star and 2-star facilities. In addition, the team found that both urban and non-profit facilities are likely to be on the waiting list, even though facilities in the urban environment are likely to be rated 1 and 2 stars. bottom.

The authors hope that integrating the waiting list rates into the current DFC rating will increase referral rates and thus improve the overall quality of facilities nationwide.

Joel Adler, MD, and MPH, lead authors of Brigam’s CSPH and Transplant Surgery Division, said: “For patients who experience this system and make decisions based on these quality indicators, it is important to integrate variables such as waiting list rates that can radically change patient outcomes.”

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