Format

Send to:

Choose Destination
See comment in PubMed Commons below
Clin J Am Soc Nephrol. 2010 Feb;5(2):307-13. doi: 10.2215/CJN.04430709. Epub 2010 Jan 7.

Variation in fistula use across dialysis facilities: is it explained by case-mix?

Author information

  • 1Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.

Abstract

BACKGROUND AND OBJECTIVES:

Arteriovenous fistulas (AVFs) remain the preferred vascular access for hemodialysis patients. Dialysis facilities that fail to meet Centers for Medicare & Medicaid Services goals cite patient case-mix as a reason for low AVF prevalence. This study aimed to determine the magnitude of the variability in AVF usage across dialysis facilities and the extent to which patient case-mix explains it.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

The vascular access used in 10,112 patients dialyzed at 173 Dialysis Clinic Inc. facilities from October 1 to December 31, 2004, was evaluated. The access in use was considered to be an AVF if it was used for >70% of hemodialysis treatments. Mixed-effects models with a random intercept for dialysis facilities evaluated the effect of facilities on AVF usage. Sequentially adjusted multivariate models measured the extent to which patient factors (case-mix) explain variation across facilities in AVF rates.

RESULTS:

3787 patients (38%) were dialyzed using AVFs. There was a significant facility effect: 7.6% of variation in AVF use was attributable to facility. This was reduced to 7.1% after case-mix adjustment. There were no identified specific facility-level factors that explained the interfacility variation.

CONCLUSIONS:

AVF usage varies across dialysis facilities, and patient case-mix did not reduce this variation. In this study, 92% of the total variation in AVF usage was due to patient factors, but most were not measurable. A combination of patient factors and process indicators should be considered in adjudicating facility performance for this quality indicator.

PMID:
20056763
[PubMed - indexed for MEDLINE]
PMCID:
PMC2827588
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Write to the Help Desk