Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study
Abstract Background 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....
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-10-01
|
| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-017-0728-x |
| _version_ | 1818921958629179392 |
|---|---|
| author | Bjorg Thorsteinsdottir Priya Ramar LaTonya J. Hickson Megan S. Reinalda Robert C. Albright Jon C. Tilburt Amy W. Williams Paul Y. Takahashi Molly M. Jeffery Nilay D. Shah |
| author_facet | Bjorg Thorsteinsdottir Priya Ramar LaTonya J. Hickson Megan S. Reinalda Robert C. Albright Jon C. Tilburt Amy W. Williams Paul Y. Takahashi Molly M. Jeffery Nilay D. Shah |
| author_sort | Bjorg Thorsteinsdottir |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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). Conclusions 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. |
| first_indexed | 2024-12-20T01:45:55Z |
| format | Article |
| id | doaj.art-650bfbb4f8c842c5bb9d7f0928e96e8f |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-20T01:45:55Z |
| publishDate | 2017-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-650bfbb4f8c842c5bb9d7f0928e96e8f2022-12-21T19:57:46ZengBMCBMC Nephrology1471-23692017-10-011811810.1186/s12882-017-0728-xCare of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort studyBjorg Thorsteinsdottir0Priya Ramar1LaTonya J. Hickson2Megan S. Reinalda3Robert C. Albright4Jon C. Tilburt5Amy W. Williams6Paul Y. Takahashi7Molly M. Jeffery8Nilay D. Shah9Division of Primary Care Internal Medicine, Department of Medicine, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicDivision of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo ClinicDivision of Nephrology and Hypertension, Department of Medicine, Mayo ClinicBiomedical Ethics Research Program, Mayo ClinicDivision of Nephrology and Hypertension, Department of Medicine, Mayo ClinicDivision of Primary Care Internal Medicine, Department of Medicine, Mayo ClinicRobert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo ClinicDivision of Health Care Policy and Research, Department of Health Sciences Research, Mayo ClinicAbstract Background 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. Methods 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. Results 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). Conclusions 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.http://link.springer.com/article/10.1186/s12882-017-0728-xDialysisHospitalizationMortalityPrimary CareUtilization |
| spellingShingle | Bjorg Thorsteinsdottir Priya Ramar LaTonya J. Hickson Megan S. Reinalda Robert C. Albright Jon C. Tilburt Amy W. Williams Paul Y. Takahashi Molly M. Jeffery Nilay D. Shah Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study BMC Nephrology Dialysis Hospitalization Mortality Primary Care Utilization |
| title | Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study |
| title_full | Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study |
| title_fullStr | Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study |
| title_full_unstemmed | Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study |
| title_short | Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study |
| title_sort | care of the dialysis patient primary provider involvement and resource utilization patterns a cohort study |
| topic | Dialysis Hospitalization Mortality Primary Care Utilization |
| url | http://link.springer.com/article/10.1186/s12882-017-0728-x |
| work_keys_str_mv | AT bjorgthorsteinsdottir careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT priyaramar careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT latonyajhickson careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT megansreinalda careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT robertcalbright careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT jonctilburt careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT amywwilliams careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT paulytakahashi careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT mollymjeffery careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy AT nilaydshah careofthedialysispatientprimaryproviderinvolvementandresourceutilizationpatternsacohortstudy |