Dialysis facility and patient characteristics associated with utilization of home dialysis.
OBJECTIVE
Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources.


METHODS
Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network's annual reports. Facility characteristic data were collected from Medicare's Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics.


RESULTS
The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code.


CONCLUSIONS
Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive.
Walker
David R
DR
Baxter Healthcare Corporation, McGaw Park, Illinois, USA.
Inglese
Gary W
GW
Sloand
James A
JA
Just
Paul M
PM
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006437:Hemodialysis, Home / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D006278:Medicare; D008875:Middle Aged; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D011156:Population Density; D012111:Residence Characteristics / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult