title: Frequency of patient-physician contact in chronic kidney disease care and achievement of clinical performance targets.
abstract: OBJECTIVE
  To examine whether the frequency of physician contact is associated with accepted quality of care measures reflecting clinical performance in chronic kidney disease patients.
  
  
  METHODS
  Prospective cohort study of end-stage renal disease patients begun in 1995, followed for 2.5 years.
  
  
  METHODS
  76 not-for-profit US dialysis clinics.
  
  
  METHODS
  678 incident hemodialysis patients for whom we had information on average frequency of patient-physician contact at each clinic (low, monthly or less frequent; intermediate, between monthly and weekly; high, more than weekly), determined by clinic survey.
  
  
  METHODS
  Achievement of accepted 6 month clinical performance targets of albumin (> or =3.5 g/dl), calcium-phosphate (Ca-P) product (<60 mg(2)/dl(2)), dialysis dose (Kt/V > or = 1.2), vascular access type (fistula), and hemoglobin (> or =11 g/dl).
  
  
  RESULTS
  By logistic regression, patients treated at clinics reporting less frequent physician contact had lower odds of achieving most targets, statistically significantly for albumin [low, adjusted odds ratio (OR) = 0.83, 95% confidence interval (CI), 0.55-1.25; intermediate, adjusted OR = 0.62, 95% CI, 0.42-0.93; reference, high] and dialysis dose (low, adjusted OR = 0.26, 95% CI, 0.08-0.89; intermediate, adjusted OR = 0.67, 95% CI, 0.20-2.27); however, they had greater odds of achieving the hemoglobin target (low, adjusted OR = 1.94, 95% CI, 1.24-3.04; intermediate, adjusted OR = 1.89, 95% CI, 1.27-2.83). Additionally, the number of targets reached was statistically significantly lower in the monthly or less group (adjusted OR = 0.43, 95% CI, 0.20-0.94).
  
  
  CONCLUSIONS
  More frequent patient-physician contact is positively associated with the achievement of clinical performance targets in chronic kidney disease care.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, 2024 E. Monument Street, Baltimore, MD 21205, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Fink
authors.forename: John H
authors.initials: JH
authors.lastname: Sadler
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Klag
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards*; D001071:Appointments and Schedules; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009939:Organizations, Nonprofit / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010817:Physician-Patient Relations; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D006435:Renal Dialysis / Q000592:standards* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors