Albany Medical College, Albany, NY, USA.
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
J Vasc Access. 2023 Mar;24(2):246-252. doi: 10.1177/11297298211027054. Epub 2021 Jul 5.
Over 468,000 patients in the United States use hemodialysis to manage End Stage Renal Disease (ESRD). The purpose of this study was to determine whether the dialysis access Clinical Performance Measures (CPMs) of Centers for Medicare & Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) have increased arteriovenous fistula (AVF) rates and decreased long-term tunneled hemodialysis catheter (TDC) rates among hemodialysis patients in United States.
Retrospective observational study: evaluated reported AVF and long-term TDC rates of 4804 dialysis facilities which reported dialysis access data as part of the ESRD QIP from Payment Year (PY) 2014-2020. Facilities were also sorted by specific additional criteria to examine disparities in dialysis access.
Mean AVF rates of included facilities increased from 63.7% in PY 2014 to 67.2% in PY 2016 ( < 0.05), did not change in PY 2017 ( > 0.05), and declined significantly in PY 2018-2020 to 64.1% in PY 2020, near AVF rates at the inception of program. Long-term TDC rates decreased from 10.4% in PY 2014 to 9.88% in PY 2015 ( < 0.05), then increased in PY 2015-PY 2020 to rates higher than at the inception of program, at 11.8% in PY 2020 ( < 0.05). Facilities serving majority Black ZIP Code Tabulation Areas (ZCTAs) or ZCTAs with median income <$45,000 achieved significantly lower AVF rates ( < 0.05) with no significant difference in long-term TDC rates ( > 0.05). AVF rates correlated positively and long-term TDC rates correlated negatively with star rating of facilities ( < 0.05).
As one of the first financial QIPs in healthcare, the ESRD QIP has not achieved the stated goals of the CMS to increase AVF access rates above 68% and reduce long-term TDC clinical rates below 10%. Systemic disparities in race, geographic region, economic status, healthcare access, and education of providers and patients prevent successful attainment of goal metrics.
美国超过 468000 名患者使用血液透析来治疗终末期肾脏疾病（ESRD）。本研究旨在确定医疗保险和医疗补助服务中心（CMS）ESRD 质量激励计划（QIP）的透析通路临床绩效指标（CPMs）是否提高了美国血液透析患者的动静脉瘘（AVF）比率，并降低了长期隧道血液透析导管（TDC）比率。
回顾性观察性研究：评估了 2014 年至 2020 年支付年度（PY）期间，作为 ESRD QIP 的一部分报告透析通路数据的 4804 个透析设施的报告 AVF 和长期 TDC 比率。还根据特定的附加标准对设施进行分类，以检查透析通路方面的差异。
纳入设施的平均 AVF 比率从 2014 年的 63.7%增加到 2016 年的 67.2%（<0.05），2017 年没有变化（>0.05），2018 年至 2020 年显著下降到 2020 年的 64.1%，接近计划开始时的 AVF 比率。长期 TDC 比率从 2014 年的 10.4%下降到 2015 年的 9.88%（<0.05），然后在 2015 年至 2020 年期间增加到高于计划开始时的比率，2020 年为 11.8%（<0.05）。服务于主要为黑人的邮政编码区（ZCTA）或中位收入<$45000 的 ZCTA 的设施，AVF 比率明显较低（<0.05），长期 TDC 比率无显著差异（>0.05）。AVF 比率与设施星级评分呈正相关，长期 TDC 比率与设施星级评分呈负相关（<0.05）。
作为医疗保健领域首批财务 QIP 之一，ESRD QIP 尚未实现 CMS 增加 AVF 使用率超过 68%和降低长期 TDC 临床使用率低于 10%的既定目标。种族、地理位置、经济状况、医疗保健获取、提供者和患者教育方面的系统性差异阻碍了目标指标的成功实现。
