title: Impacts of Geographic Distance on Peritoneal Dialysis Utilization: Refining Models of Treatment Selection.
abstract: To examine the relationship between distance to dialysis provider and patient selection of dialysis modality, informed by the absolute distance from a patient's home and relative distance of alternative modalities.
  
  
  
  U.S. Renal Data System.
  
  
  
  About 70,131 patients initiating chronic dialysis and 4,795 dialysis facilities in 2006. The primary outcome was patient utilization of peritoneal dialysis (PD). Independent variables included absolute distance between patients' home and the nearest hemodialysis (HD) facility, relative distance between patients' home and nearest PD versus nearest HD facilities, and their interaction. Logistic regression was used to model distance on PD use, controlling for patient and market characteristics.
  
  
  
  Nine percent of incident dialysis patients used PD in 2006. There was a positive, nonlinear relationship between absolute distance to HD services and PD use (p < .0001), with the magnitude of the effect increasing at greater distances. In terms of relative distance, odds of PD use increased if a PD facility was closer or the same distance as the nearest HD facility (p = .006). Interaction of distance measures to dialysis facilities was not significant.
  
  
  
  Analyses of patient choice between alternative treatments should model distance to reflect all relevant dimensions of geographic access to treatment options.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC.|Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC.
authors.forename: Virginia
authors.initials: V
authors.lastname: Wang
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC.|Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC.|Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Sanders
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Shoou-Yih Daniel
authors.initials: SD
authors.lastname: Lee
authors.affiliation: Department of Health Management and Policy, University of Michigan, Ann Arbor, MI.
authors.forename: Richard
authors.initials: R
authors.lastname: Hirth
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Michigan, Internal Medicine-Nephrology, Ann Arbor, MI.
authors.forename: Joseph
authors.initials: J
authors.lastname: Messana
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D057240:Patient Preference / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D014481:United States
keywords: Dialysis; geographic distance; treatment selection