title: Impact of pay for performance on access at first dialysis in Queensland.
abstract: OBJECTIVE
  Commencement of haemodialysis with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) is associated with improved survival compared with commencement with a central venous catheter. In 2011-2012, Queensland Health made incentive payments to renal units for early referred patients who commenced peritoneal dialysis (PD), or haemodialysis with an AVF/AVG. The aim of this study was to determine if pay for performance improved clinical care.
  
  
  METHODS
  All patients who commenced dialysis in Australia between 2009 and 2014 and were registered with the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) were included. A multivariable regression model was used to compare rates of commencing dialysis with a PD catheter or permanent AVF/AVG during the pay-for-performance period (2011-2012) with periods prior (2009-2010) and after (2013-2014).
  
  
  RESULTS
  A total of 10 858 early referred patients commenced dialysis during the study period, including 2058 in Queensland. In Queensland, PD as first modality increased with time (P < 0.001) but there was no change in AVF/AVG rate at first haemodialysis (P = 0.5). In a multivariate model using the pay-for-performance period as reference, the odds ratio for commencement with PD or haemodialysis with an AVF/AVG in Queensland was 1.02 (95% CI 0.81-1.29) in 2009-2010 and 1.28 (95% CI 1.01-1.61) in 2013-2014. There was no change for the rest of Australia (0.97 95% CI 0.87-1.09 in 2009-2010 and 1.00 95% CI 0.90-1.11 in 2013-14).
  
  
  CONCLUSIONS
  Pay for performance did not improve rates of commencement of dialysis with PD or an AVF/AVG during the payment period. A lag effect on clinical care may explain the improvement in later years.
authors.affiliation: Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia.
authors.forename: Jennie
authors.identifier: http://orcid.org/0000-0001-9360-8098
authors.initials: J
authors.lastname: Haarsager
authors.affiliation: Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia.|Sunshine Coast Clinical School, Nambour General Hospital, The University of Queensland, Nambour, Queensland, Australia.|Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.
authors.forename: Rathika
authors.initials: R
authors.lastname: Krishnasamy
authors.affiliation: Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia.|Sunshine Coast Clinical School, Nambour General Hospital, The University of Queensland, Nambour, Queensland, Australia.|Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.
authors.forename: Nicholas A
authors.identifier: http://orcid.org/0000-0001-9112-0304
authors.initials: NA
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics* / Q000639:trends; D015397:Program Evaluation; D058996:Quality Improvement / Q000191:economics* / Q000639:trends; D019984:Quality Indicators, Health Care / Q000191:economics* / Q000639:trends; D011793:Queensland; D012017:Referral and Consultation / Q000191:economics; D012052:Reimbursement, Incentive / Q000191:economics* / Q000639:trends; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics* / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ANZDATA; dialysis; pay for performance; quality improvement; vascular access