Format

Send to

Choose Destination
Health Serv Res. 2011 Jun;46(3):747-67. doi: 10.1111/j.1475-6773.2010.01219.x. Epub 2010 Dec 9.

The effect of dialysis chains on mortality among patients receiving hemodialysis.

Author information

1
Medical Technology and Practice Patterns Institute, 4733 Bethesda Ave., Bethesda, MD 20814, USA. yz@mtppi.org

Abstract

OBJECTIVE:

To examine the association between dialysis facility chain affiliation and patient mortality.

STUDY SETTING:

Medicare dialysis population.

STUDY DESIGN:

Data from the United States Renal Data System (USRDS) were used to identify 3,601 free-standing dialysis facilities and 34,914 Medicare patients' incidence to end-stage renal disease (ESRD) in 2004. Mixed-effect regression models were used to estimate patient mortality by dialysis facility chain and profit status during the 2-year follow-up.

DATA COLLECTION:

USRDS data were matched with facility, cost, and census data.

PRINCIPAL FINDINGS:

Of the five largest dialysis chains, the lowest mortality risk was observed among patients dialyzed at nonprofit (NP) Chain 5 facilities. Compared with Chain 5, hazard ratios were 19 percent higher (95 percent CI 1.06-1.34) and 24 percent higher (95 percent CI 1.10-1.40) for patients dialyzed at for-profit (FP) Chain 1 and Chain 2 facilities, respectively. In addition, patients at FP facilities had a 13 percent higher risk of mortality than those in NP facilities (95 percent CI 1.06-1.22).

CONCLUSIONS:

Large chain affiliation is an independent risk factor for ESRD mortality in the United States. Given the movement toward further consolidation of large FP chains, reasons behind the increase in mortality require scrutiny.

PMID:
21143480
PMCID:
PMC3097400
DOI:
10.1111/j.1475-6773.2010.01219.x
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center