title: Geographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort study.
abstract: BACKGROUND
  Peritoneal dialysis is associated with similar survival and similar improvement in quality of life and is less costly compared with in-centre hemodialysis. We examined facility and geographic variation in the use of peritoneal dialysis in Canada.
  
  
  METHODS
  We analyzed data from the Canadian Organ Replacement Register for the period January 2001 to December 2010. We identified patients for whom peritoneal dialysis was the primary modality at 90 days after initiation of dialysis. We used multilevel models to evaluate variation in use of peritoneal dialysis by facility and geographic region.
  
  
  RESULTS
  We analyzed data for 31 778 incident dialysis patients at 56 facilities in 13 geographic regions across Canada. Use of peritoneal dialysis at 90 days varied considerably across geographic regions (range 19.8%-36.1%) and declined over time, from 28.8% in 2001 to 22.5% in 2010. After adjustment for case mix and facility-level quality indicators, 9.3% and 3.4% of the variability was attributable to facility and geographic factors, respectively. In adjusted models, there was a substantial difference between geographic regions with the lowest and highest peritoneal dialysis use (odds ratio for high use 1.51, 95% confidence interval [CI] 1.33-1.73 v. odds ratio for low use 0.69, 95% CI 0.60-0.79).
  
  
  CONCLUSIONS
  In Canada, substantial variability in the use of peritoneal dialysis attributable to facility and geographic region was not explained by differences in patient case mix. An opportunity exists to optimize use of this cost-effective therapy through changes in policy and standardization of criteria for initiation of peritoneal dialysis.
authors: The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.
authors: Manish M
authors: MM
authors: Sood
authors: Seven Oaks Hospital, University of Manitoba, Winnipeg, Man.
authors: Navdeep
authors: N
authors: Tangri
authors: Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Man.
authors: Brett
authors: B
authors: Hiebert
authors: Saskatoon Health Region, University of Saskatchewan, Saskatoon, Sask.
authors: Joanne
authors: J
authors: Kappel
authors: Health Sciences Centre, University of Manitoba, Winnipeg, Man.
authors: Allison
authors: A
authors: Dart
authors: St Paul's Hospital, University of British Columbia, Vancouver, BC.
authors: Adeera
authors: A
authors: Levin
authors: Foothills Hospital, University of Calgary, Calgary, Alta.
authors: Braden
authors: B
authors: Manns
authors: Faculty of Nursing, University of Alberta, Edmonton, Alta.
authors: Anita
authors: A
authors: Molzahn
authors: Sunnybrook Hospital, University of Toronto, Toronto, Ont.
authors: David
authors: D
authors: Naimark
authors: Jewish General Hospital, McGill University, Montreal, Que.
authors: Sharon J
authors: SJ
authors: Nessim
authors: Seven Oaks Hospital, University of Manitoba, Winnipeg, Man.
authors: Claudio
authors: C
authors: Rigatto
authors: Dalhousie University, Halifax, NS.
authors: Steven D
authors: SD
authors: Soroka
authors: McGill University Health Centre, McGill University, Montreal, Que.
authors: Michael
authors: M
authors: Zappitelli
authors: Seven Oaks Hospital, University of Manitoba, Winnipeg, Man.
authors: Paul
authors: P
authors: Komenda