Care of the dialysis patient: Primary provider involvement and resource utilization patterns - A cohort study

Bjoerg (Bjorg) Thorsteinsdottir, Priya Ramar, LaTonya Hickson, Megan S. Reinalda, Robert C. Albright, Jon C Tilburt, Amy W. Williams, Paul Y Takahashi, Molly M. Jeffery, Nilay D Shah

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Article number322
JournalBMC Nephrology
Volume18
Issue number1
DOIs
StatePublished - Oct 25 2017

Fingerprint

Dialysis
Primary Health Care
Patient Care
Cohort Studies
Renal Dialysis
Accountable Care Organizations
Current Procedural Terminology
Patient Acceptance of Health Care
Survival
Hospital Emergency Service
Comorbidity
Hospitalization
Outpatients
Retrospective Studies
Databases
Transplants
Kidney

Keywords

  • Dialysis
  • Hospitalization
  • Mortality
  • Primary Care
  • Utilization

ASJC Scopus subject areas

  • Nephrology

Cite this

Care of the dialysis patient : Primary provider involvement and resource utilization patterns - A cohort study. / Thorsteinsdottir, Bjoerg (Bjorg); Ramar, Priya; Hickson, LaTonya; Reinalda, Megan S.; Albright, Robert C.; Tilburt, Jon C; Williams, Amy W.; Takahashi, Paul Y; Jeffery, Molly M.; Shah, Nilay D.

In: BMC Nephrology, Vol. 18, No. 1, 322, 25.10.2017.

Research output: Contribution to journalArticle

@article{6e3f8c97ee58450980c6aeb85a19576c,
title = "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. 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.",
keywords = "Dialysis, Hospitalization, Mortality, Primary Care, Utilization",
author = "Thorsteinsdottir, {Bjoerg (Bjorg)} and Priya Ramar and LaTonya Hickson and Reinalda, {Megan S.} and Albright, {Robert C.} and Tilburt, {Jon C} and Williams, {Amy W.} and Takahashi, {Paul Y} and Jeffery, {Molly M.} and Shah, {Nilay D}",
year = "2017",
month = "10",
day = "25",
doi = "10.1186/s12882-017-0728-x",
language = "English (US)",
volume = "18",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Care of the dialysis patient

T2 - Primary provider involvement and resource utilization patterns - A cohort study

AU - Thorsteinsdottir, Bjoerg (Bjorg)

AU - Ramar, Priya

AU - Hickson, LaTonya

AU - Reinalda, Megan S.

AU - Albright, Robert C.

AU - Tilburt, Jon C

AU - Williams, Amy W.

AU - Takahashi, Paul Y

AU - Jeffery, Molly M.

AU - Shah, Nilay D

PY - 2017/10/25

Y1 - 2017/10/25

N2 - 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.

AB - 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.

KW - Dialysis

KW - Hospitalization

KW - Mortality

KW - Primary Care

KW - Utilization

UR - http://www.scopus.com/inward/record.url?scp=85032173396&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032173396&partnerID=8YFLogxK

U2 - 10.1186/s12882-017-0728-x

DO - 10.1186/s12882-017-0728-x

M3 - Article

C2 - 29070040

AN - SCOPUS:85032173396

VL - 18

JO - BMC Nephrology

JF - BMC Nephrology

SN - 1471-2369

IS - 1

M1 - 322

ER -