title: Provider visit frequency and vascular access interventions in hemodialysis.
abstract: OBJECTIVE
  Medicare reimbursement policy encourages frequent provider visits to patients with ESRD undergoing hemodialysis. This study sought to determine whether more frequent face-to-face provider (physician and advanced practitioner) visits lead to more procedures and therapeutic interventions aimed at preserving arteriovenous fistulas and grafts, improved vascular access outcomes, and fewer related hospitalizations.
  
  
  METHODS
  Multivariable regression was used to evaluate the association between provider (physician and advanced practitioner) visit frequency and interventions aimed at preserving vascular access, vascular access survival, hospitalization for vascular access infection, and outpatient antibiotic use in a cohort of 63,488 Medicare beneficiaries receiving hemodialysis in the United States. Medicare claims were used to identify the type of vascular access used, access-related events, and vascular access failure.
  
  
  RESULTS
  One additional provider (physician and advanced practitioner) visit per month was associated with a 13% higher odds of receiving an intervention to preserve vascular access (95% confidence interval [95% CI], 12% to 14%) but was not associated with vascular access survival (hazard ratio, 1.01; 95% CI, 0.99 to 1.03). One additional provider visit was associated with a 9% (95% CI, 5% to 14%) lower odds of hospitalization for vascular access infection and a corresponding 9% (95% CI, 5% to 14%) higher odds of outpatient intravenous antibiotic administration. However, the associated changes in absolute probabilities of hospitalization and antibiotic administration were small.
  
  
  CONCLUSIONS
  More frequent face-to-face provider (physician and advanced practitioner) visits were associated with more procedures and therapeutic interventions aimed at preserving vascular accesses, but not with prolonged vascular access survival and only a small decrease in hospitalization for vascular access.
authors.affiliation: Division of Nephrology, Department of Medicine, Center for Primary Care and Outcomes Research, Department of Medicine, and kevine1@stanford.edu.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Erickson
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Mell
authors.affiliation: Section of Nephrology, Baylor College of Medicine, Houston, Texas.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Division of Nephrology, Department of Medicine.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Center for Primary Care and Outcomes Research, Department of Medicine, and.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology; D006435:Renal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: and outcomes; arteriovenous fistula; arteriovenous graft; chronic hemodialysis; economic analysis; epidemiology