TY - JOUR
T1 - Provider and care characteristics associated with timing of dialysis initiation
AU - Slinin, Yelena
AU - Guo, Haifeng
AU - Li, Suying
AU - Liu, Jiannong
AU - Morgan, Benjamin
AU - Ensrud, Kristine
AU - Gilbertson, David T.
AU - Collins, Allan J.
AU - Ishani, Areef
PY - 2014
Y1 - 2014
N2 - Background and objectives: There is a trend in the United States to maintenance dialysis initiation at higher levels of estimated GFR. This study aimed to determine whether provider characteristics and pre-ESRD nephrology care and vascular access are independently associated with higher estimated GFR at initiation. Design, setting, participants, & measurements: This retrospective cohort study used US Renal Data System data for patients who initiated dialysis in 2006 (n=83,621) and American Medical Association Physician Master File data for provider characteristics. Patient characteristics and estimated GFR were defined, and providers at dialysis initiation were identified. Earlier dialysis initiation was defined as initiation at estimated GFR>10 ml/min per 1.73 m2. Nephrologist density per 100 ESRD patients was calculated by Health Service Area in 2006. Associations between provider characteristics and estimated GFR were determined using logistic regression and linear regression models, accounting for provider clustering. Results: Of the cohort, 47.8% of patients initiated dialysis at estimated GFR>10 ml/min per 1.73 m2, and 16.2% of patients initiated dialysis at estimated GFR≥15 ml/min per 1.73 m2. Predialysis nephrologist care for 0-12 months was associated with greater odds of earlier initiation compared with no care. Patients initiating with an arteriovenous fistula or graft were more likely to initiate earlier than patients initiating with a catheter. Provider sex was not associated with timing of dialysis initiation as measured by estimated GFR. Care by providers who graduated from nondomestic medical schools was associated with greater odds of earlier initiation. Greater provider experience was associated with lower likelihood of earlier initiation. Conclusion: This study supports the hypothesis that provider factors are associated with timing of dialysis initiation in the United States.
AB - Background and objectives: There is a trend in the United States to maintenance dialysis initiation at higher levels of estimated GFR. This study aimed to determine whether provider characteristics and pre-ESRD nephrology care and vascular access are independently associated with higher estimated GFR at initiation. Design, setting, participants, & measurements: This retrospective cohort study used US Renal Data System data for patients who initiated dialysis in 2006 (n=83,621) and American Medical Association Physician Master File data for provider characteristics. Patient characteristics and estimated GFR were defined, and providers at dialysis initiation were identified. Earlier dialysis initiation was defined as initiation at estimated GFR>10 ml/min per 1.73 m2. Nephrologist density per 100 ESRD patients was calculated by Health Service Area in 2006. Associations between provider characteristics and estimated GFR were determined using logistic regression and linear regression models, accounting for provider clustering. Results: Of the cohort, 47.8% of patients initiated dialysis at estimated GFR>10 ml/min per 1.73 m2, and 16.2% of patients initiated dialysis at estimated GFR≥15 ml/min per 1.73 m2. Predialysis nephrologist care for 0-12 months was associated with greater odds of earlier initiation compared with no care. Patients initiating with an arteriovenous fistula or graft were more likely to initiate earlier than patients initiating with a catheter. Provider sex was not associated with timing of dialysis initiation as measured by estimated GFR. Care by providers who graduated from nondomestic medical schools was associated with greater odds of earlier initiation. Greater provider experience was associated with lower likelihood of earlier initiation. Conclusion: This study supports the hypothesis that provider factors are associated with timing of dialysis initiation in the United States.
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U2 - 10.2215/CJN.04190413
DO - 10.2215/CJN.04190413
M3 - Article
C2 - 24436477
AN - SCOPUS:84893607557
SN - 1555-9041
VL - 9
SP - 310
EP - 317
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 2
ER -