Hemodialysis patient outcomes: provider characteristics.
OBJECTIVE
Physician characteristics are associated with differential performance on quality measures and patient outcomes in several medical fields. We aimed to determine whether characteristics of physicians who provide care to dialysis patients were associated with patient outcomes.


METHODS
This cohort study used United States Renal Data System data for patients who initiated in-center hemodialysis between October 1, 2003, and September 30, 2006 (n = 91,276). Patient characteristics were defined and physicians identified from Part B Medicare claims for outpatient dialysis services submitted during months 4-6 of hemodialysis. Physician characteristics were obtained from the American Medical Association Physician Master File. Associations of physician characteristics with 1-year patient mortality and first hospitalization were determined using Cox proportional hazards analysis; associations with quality of care (defined by influenza vaccination and waitlisting for kidney transplant) were determined using logistic regression.


RESULTS
Physician characteristics were not associated with patient mortality. After adjustment for patient and other provider characteristics, patients whose physicians had practiced longer or were in administrative, research, or teaching practices were more likely to be hospitalized; patients whose providers practiced in smaller metropolitan statistical areas (MSAs) were less likely. More years since training was associated with greater chance of waitlisting, and practicing in smaller MSAs with less chance. Graduation from a foreign medical school, practicing in smaller MSAs, and travelling farther from office to dialysis unit were associated with greater odds of influenza vaccination.


CONCLUSIONS
Several characteristics of physicians seeing incident outpatient hemodialysis patients were associated with hospitalization and quality of care, but none with mortality.
Veterans Administration Health Care System, Minneapolis, Minn., USA.
Yelena
Y
Slinin
Haifeng
H
Guo
Suying
S
Li
Jiannong
J
Liu
Kristine
K
Ensrud
David T
DT
Gilbertson
Allan J
AJ
Collins
Areef
A
Ishani
D000328:Adult; D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual; D004501:Education, Medical / Q000706:statistics & numerical data; D005180:Faculty, Medical / Q000706:statistics & numerical data; D005260:Female; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult