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Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study
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 st...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657054/ https://www.ncbi.nlm.nih.gov/pubmed/29070040 http://dx.doi.org/10.1186/s12882-017-0728-x |
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author | Thorsteinsdottir, Bjorg Ramar, Priya Hickson, LaTonya J. Reinalda, Megan S. Albright, Robert C. Tilburt, Jon C. Williams, Amy W. Takahashi, Paul Y. Jeffery, Molly M. Shah, Nilay D. |
author_facet | Thorsteinsdottir, Bjorg Ramar, Priya Hickson, LaTonya J. Reinalda, Megan S. Albright, Robert C. Tilburt, Jon C. Williams, Amy W. Takahashi, Paul Y. Jeffery, Molly M. Shah, Nilay D. |
author_sort | Thorsteinsdottir, Bjorg |
collection | PubMed |
description | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-017-0728-x) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5657054 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-56570542017-10-31 Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study Thorsteinsdottir, Bjorg Ramar, Priya Hickson, LaTonya J. Reinalda, Megan S. Albright, Robert C. Tilburt, Jon C. Williams, Amy W. Takahashi, Paul Y. Jeffery, Molly M. Shah, Nilay D. BMC Nephrol Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-017-0728-x) contains supplementary material, which is available to authorized users. BioMed Central 2017-10-25 /pmc/articles/PMC5657054/ /pubmed/29070040 http://dx.doi.org/10.1186/s12882-017-0728-x Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Thorsteinsdottir, Bjorg Ramar, Priya Hickson, LaTonya J. Reinalda, Megan S. Albright, Robert C. Tilburt, Jon C. Williams, Amy W. Takahashi, Paul Y. Jeffery, Molly M. Shah, Nilay D. Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study |
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 | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657054/ https://www.ncbi.nlm.nih.gov/pubmed/29070040 http://dx.doi.org/10.1186/s12882-017-0728-x |
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