Referral for Kidney Transplantation and Indicators of Quality of Dialysis Care: A Cross-sectional Study

• Type of Material: Article
• Authors: Laura Christine Plantinga, Emory University; Stephen Pastan, Emory University; Adam S Wilk, Emory University; Jenna Krisher, Alliant Health Solutions; Laura Mulloy, Augusta University; Eric M. Gibney, Piedmont Healthcare; Rachel Elizabeth Patzer, Emory University
• Language: English
• Date: 2017-02-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 National Kidney Foundation, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1053/j.ajkd.2016.08.038
• Title of Journal or Parent Work: American Journal of Kidney Diseases
• ISSN: 0272-6386
• Volume: 69
• Issue: 2
• Start Page: 257
• End Page: 265
• Grant/Funding Information: This work was supported by National Institute on Minority Health and Health Disparities R24MD008077.
• Keywords: quality indicator; Quality of care; Science & Technology; ACCESS; dialysis facility; FACILITY; SOUTHEAST; pay-for-performance; kidney transplantation; UNITED-STATES; Urology & Nephrology; end-stage renal disease (ESRD); renal replacement therapy (RRT); performance indicator; STAGE RENAL-DISEASE; RRT modality; dialysis; referral; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background Dialysis facility performance measures to improve access to kidney transplantation are being considered. Referral of patients for kidney transplantation evaluation by the dialysis facility is one potential indicator, but limited data exist to evaluate whether referral is associated with existing dialysis facility quality indicators. Study Design Cross-sectional study. Setting & Participants 12,926 incident (July 2005 to September 2011) adult (aged 18-69 years) patients treated at 241 dialysis facilities with complete quality indicator information from US national registry data linked to transplantation referral data from all 3 Georgia kidney transplantation centers. Factors Facility performance on dialysis quality indicators (high, intermediate, and low tertiles). Outcome Percentages of patients referred within 1 year of dialysis therapy initiation at dialysis facility. Results Overall, a median of 25.4% of patients were referred for kidney transplantation within 1 year of dialysis therapy initiation. Higher facility-level referral was associated with better performance with respect to standardized transplantation ratio (high, 28.6%; intermediate, 25.1%; and low, 22.9%; P = 0.001) and percentage waitlisted (high, 30.7%; intermediate, 26.8%; and low, 19.2%; P  <  0.001). Facility-level referral was not associated with indicators of quality of care associated with dialysis therapy initiation, including percentage of incident patients being informed of transplantation options. For most non−transplantation-related indicators of high-quality care, including those capturing mortality, morbidity, and anemia management, better performance was not associated with higher facility-level transplantation referral. Limitations Potential ecologic fallacy and residual confounding. Conclusions Transplantation referral among patients at dialysis facilities does not appear to be associated with overall quality of dialysis care at the facility. Quality indicators related to kidney transplantation were positively associated with, but not entirely correspondent with, higher percentages of patients referred for kidney transplantation evaluation from dialysis facilities. These results suggest that facility-level referral, which is within the control of the dialysis facility, may provide information about the quality of dialysis care beyond current indicators.