Saunders Milda R, Lee Haena, Chin Marshall H
University of Chicago Medicine, 5841 S. Maryland, MC 2007, Chicago, IL, 60637, USA.
Institute for Social Research, University of Michigan, 426 Thompson St., #3428, Ann Arbor, MI, USA.
BMC Health Serv Res. 2017 Dec 8;17(1):816. doi: 10.1186/s12913-017-2764-4.
We examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to determine its potential impact on quality and disparities in dialysis care.
We linked the 2012 ESRD QIP Facility Performance File to the 2007-2011 American Community Survey by zip code and dichotomized the QIP total performance scores-derived from percent of patients with urea reduction rate > 65, hemoglobin < 10 g/dL, and hemoglobin > 12 g/dL-as 'any' versus 'no' payment reduction. We characterized associations between payment reduction and dialysis facility characteristics and neighborhood demographics, and examined changes in facility outcomes between 2007 and 2010.
In multivariable analysis, facilities with any payment reduction were more likely to have longer operation (OR 1.03 per year), a medium or large number of stations (OR 1.31 and OR 1.42, respectively), and a larger proportion of African Americans (OR 1.25, highest versus lowest quartile), all p < 0.05. Most improvement in clinical performance was due to reduced overtreatment of anemia, a decline in the percentage of patients with hemoglobin ≥ 12 g/dL; for-profits and facilities in African American neighborhoods had the greatest reduction.
In the first year of CMS pay-for-performance, most clinical improvement was due to reduced overtreatment of anemia. Facilities in African American neighborhoods were more likely to receive a payment reduction, despite their large decline in anemia overtreatment.
我们研究了在美国医疗保险和医疗补助服务中心（CMS）终末期肾病质量激励计划（ESRD QIP）的第一年，透析机构特征与支付减少以及临床绩效指标变化之间的关联，以确定其对透析护理质量和差异的潜在影响。
我们通过邮政编码将2012年ESRD QIP机构绩效文件与2007 - 2011年美国社区调查相链接，并将QIP总绩效得分（源自尿素清除率>65%、血红蛋白<10 g/dL和血红蛋白>12 g/dL的患者百分比）分为“有”与“无”支付减少两类。我们描述了支付减少与透析机构特征及社区人口统计学之间的关联，并研究了2007年至2010年期间机构结果的变化。
在多变量分析中，有任何支付减少的机构更有可能运营时间更长（每年OR为1.03）、站点数量为中等或大型（分别为OR 1.31和OR 1.42）以及非裔美国人比例更高（OR 1.25，最高四分位数与最低四分位数相比），所有p<0.05。临床绩效的最大改善归因于贫血过度治疗的减少，即血红蛋白≥12 g/dL的患者百分比下降；营利性机构和非裔美国人社区的机构下降幅度最大。
在CMS绩效付费的第一年，大多数临床改善归因于贫血过度治疗的减少。尽管非裔美国人社区的机构贫血过度治疗大幅下降，但它们更有可能获得支付减少。
