title: Who is caring for kidney transplant patients? Variation by region, transplant center, and patient characteristics.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415-1829, USA. isran001@umn.edu
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Skeans
authors.forename: Anne V
authors.initials: AV
authors.lastname: Tuomari
authors.forename: J Ross
authors.initials: JR
authors.lastname: Maclean
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult