Szczech L A, Klassen P S, Chua B, Hedayati S S, Flanigan M, McClellan W M, Reddan D N, Rettig R A, Frankenfield D L, Owen W F
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27710, USA.
Kidney Int. 2006 Jun;69(11):2094-100. doi: 10.1038/sj.ki.5000267.
Prior studies observing greater mortality in for-profit dialysis units have not captured information about benchmarks of care. This study was undertaken to examine the association between profit status and mortality while achieving benchmarks. Utilizing data from the US Renal Data System and the Centers for Medicare & Medicaid Services' end-stage renal disease (ESRD) Clinical Performance Measures project, hemodialysis units were categorized as for-profit or not-for-profit. Associations with mortality at 1 year were estimated using Cox regression. Two thousand six hundred and eighty-five dialysis units (31,515 patients) were designated as for-profit and 1018 (15,085 patients) as not-for-profit. Patients in for-profit facilities were more likely to be older, black, female, diabetic, and have higher urea reduction ratio (URR), hematocrit, serum albumin, and transferrin saturation. Patients (19.4 and 18.6%) in for-profit and not-for-profit units died, respectively. In unadjusted analyses, profit status was not associated with mortality (hazard ratio (HR)=1.04, P=0.09). When added to models with profit status, the following resulted in a significant association between profit status (for-profit vs not-for-profit) and increasing mortality risk: URR, hematocrit, albumin, and ESRD Network. In adjusted models, patients in for-profit facilities had a greater death risk (HR 1.09, P=0.004). More patients in for-profit units met clinical benchmarks. Survival among patients in for-profit units was similar to not-for-profit units. This suggests that in the contemporary era, interventions in for-profit dialysis units have not impaired their ability to deliver performance benchmarks and do not affect survival.
先前关于营利性透析单位死亡率更高的研究并未获取有关护理基准的信息。本研究旨在探讨营利状况与死亡率之间的关联，同时实现护理基准。利用美国肾脏数据系统以及医疗保险和医疗补助服务中心的终末期肾病（ESRD）临床绩效指标项目的数据，血液透析单位被分为营利性或非营利性。使用Cox回归估计1年时与死亡率的关联。2685个透析单位（31515名患者）被指定为营利性，1018个（15085名患者）为非营利性。营利性机构的患者更可能年龄较大、为黑人、女性、患有糖尿病，并且尿素清除率（URR）、血细胞比容、血清白蛋白和转铁蛋白饱和度更高。营利性和非营利性单位的患者死亡率分别为19.4%和18.6%。在未调整的分析中，营利状况与死亡率无关（风险比（HR）=1.04，P=0.09）。当将以下因素添加到包含营利状况的模型中时，营利状况（营利性与非营利性）与死亡率风险增加之间存在显著关联：URR、血细胞比容、白蛋白和ESRD网络。在调整后的模型中，营利性机构的患者死亡风险更高（HR 1.09，P=0.004）。营利性单位中有更多患者达到临床基准。营利性单位患者的生存率与非营利性单位相似。这表明在当代，对营利性透析单位的干预并未损害其实现绩效基准的能力，也不影响生存率。
