title: Hemodialysis treatment center early mortality rates for incident hemodialysis patients are associated with the quality of care prior to starting but not following onset of dialysis.
abstract: BACKGROUND
  We examined the independent contribution of pre-ESRD (end-stage renal disease) care and care after starting hemodialysis (post-HD) with facility-specific mortality among incident patients.
  
  
  METHODS
  We studied 6,217 incident patients treated at 311 dialysis facilities. A pre-ESRD care score was assessed as the sum of quality measures met on the Centers for Medicare and Medicaid Services Form 2728, including predialysis nephrology and dietary care, having a fistula, hemoglobin and serum albumin. A post-HD care score was evaluated by the sum of quality targets attained, including HD adequacy, anemia, serum albumin and hemoglobin measured on an annual quality survey. A fifth post-HD care measure was having obtained an influenza vaccination during the current year.
  
  
  RESULTS
  Individual patient mortality was associated with both pre-ESRD (p < 0.001) and post-HD (p < 0.001) care scores. Linear regression models including both pre-ESRD and post-HD care scores showed that a 1-point increase in the pre-ESRD care score resulted in a 0.30 (95% CI: -0.47, -0.12) decreased facility standardized mortality ratio; no association for post-HD care score was noted (-0.11; 95% CI: -0.26, 0.04).
  
  
  CONCLUSIONS
  Pre-ESRD and post-HD care are both strongly associated with individual patient mortality. In contrast, only pre-ESRD care is associated with facility mortality, suggesting that early mortality reflects differences in pre-ESRD care in the community.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Kanda
authors.forename: Kevin
authors.initials: K
authors.lastname: Erickson
authors.forename: T Christopher
authors.initials: TC
authors.lastname: Bond
authors.forename: Jenna
authors.initials: J
authors.lastname: Krisher
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D005845:Georgia; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011787:Quality of Health Care; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods*; D012306:Risk; D012709:Serum Albumin / Q000378:metabolism; D013022:South Carolina; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin