TY - JOUR
T1 - Who is caring for kidney transplant patients? variation by region, transplant center, and patient characteristics
AU - Israni, Ajay K.
AU - Snyder, Jon J.
AU - Skeans, Melissa A.
AU - Tuomari, Anne V.
AU - MacLean, J. Ross
AU - Kasiske, Bertram L.
PY - 2009/11
Y1 - 2009/11
N2 - Background/Aims: Despite implications for long-term care, little is known about outpatient care for kidney transplant patients. Methods: In this retrospective observational cohort study, outpatient claims were examined for 42,078 Medicare kidney transplant patients using United States Renal Data System data to ascertain location and timing of outpatient visits and type of physician seen. Logistic regression with generalized estimating equations was used to determine the odds and clinical correlates of visits in 4 post-transplant time periods. Results: In months 1-3, 88% of patients visited their transplant centers, but this declined to 69% in months 25-36. In the adjusted analysis, Native Americans (odds ratio 0.56, 95% confidence interval 0.48-0.65) and Hispanics (OR 0.86, 95% CI 0.80-0.92) were less likely than whites to visit their transplant centers. Centers performing 18-34 (OR 1.44, 95% CI 1.30-1.59) and 35-61 transplants per year (OR 1.30, 95% CI 1.18-1.43) were more likely to see patients than centers performing <18 or >61. Almost 80% of patients saw nephrologists in months 1-3 after transplant. African-Americans (OR 0.85, 95% CI 0.80-0.90), Asians (OR 0.87, 95% CI 0.77-0.97), and Native Americans (OR 0.63, 95% CI 0.53-0.75) were less likely than whites to see nephrologists, as were Hispanics (OR 0.78, 95% CI 0.72-0.84) compared with non-Hispanics. Conclusion: Frequency of visits to transplant centers varied by center and region; most visits were to nephrologists. Patients from minority groups were less likely to visit transplant centers and nephrologists, with possibly significant public health implications.
AB - Background/Aims: Despite implications for long-term care, little is known about outpatient care for kidney transplant patients. Methods: In this retrospective observational cohort study, outpatient claims were examined for 42,078 Medicare kidney transplant patients using United States Renal Data System data to ascertain location and timing of outpatient visits and type of physician seen. Logistic regression with generalized estimating equations was used to determine the odds and clinical correlates of visits in 4 post-transplant time periods. Results: In months 1-3, 88% of patients visited their transplant centers, but this declined to 69% in months 25-36. In the adjusted analysis, Native Americans (odds ratio 0.56, 95% confidence interval 0.48-0.65) and Hispanics (OR 0.86, 95% CI 0.80-0.92) were less likely than whites to visit their transplant centers. Centers performing 18-34 (OR 1.44, 95% CI 1.30-1.59) and 35-61 transplants per year (OR 1.30, 95% CI 1.18-1.43) were more likely to see patients than centers performing <18 or >61. Almost 80% of patients saw nephrologists in months 1-3 after transplant. African-Americans (OR 0.85, 95% CI 0.80-0.90), Asians (OR 0.87, 95% CI 0.77-0.97), and Native Americans (OR 0.63, 95% CI 0.53-0.75) were less likely than whites to see nephrologists, as were Hispanics (OR 0.78, 95% CI 0.72-0.84) compared with non-Hispanics. Conclusion: Frequency of visits to transplant centers varied by center and region; most visits were to nephrologists. Patients from minority groups were less likely to visit transplant centers and nephrologists, with possibly significant public health implications.
KW - Kidney transplantation
KW - Outpatient care
KW - Postoperative care
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U2 - 10.1159/000239220
DO - 10.1159/000239220
M3 - Article
C2 - 19752531
AN - SCOPUS:70049104568
SN - 0250-8095
VL - 30
SP - 430
EP - 439
JO - American Journal of Nephrology
JF - American Journal of Nephrology
IS - 5
ER -