Division of Nephrology, Stanford University School of Medicine, Stanford, California.
Selzman Institute for Kidney Health and Section of Nephrology, Baylor College of Medicine, Houston, Texas.
Clin J Am Soc Nephrol. 2021 Jul;16(7):1052-1060. doi: 10.2215/CJN.16621020. Epub 2021 Jul 12.
New payment models resulting from the Advancing American Kidney Health initiative may create incentives for nephrologists to focus less on face-to-face in-center hemodialysis visits. This study aimed to understand whether more frequent nephrology practitioner dialysis visits improved patient experience and could help inform future policy.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a cross-sectional study of patients receiving dialysis from April 1, 2015 through January 31, 2016, we linked patient records from a national kidney failure registry to patient experience data from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems survey. We used a multivariable mixed effects linear regression model to examine the association between nephrology practitioner visit frequency and patient-reported experiences with nephrologist care.
Among 5125 US dialysis facilities, 2981 (58%) had ≥30 In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems surveys completed between April 2015 and January 2016, and 243,324 patients receiving care within these facilities had Medicare Parts A/B coverage. Face-to-face practitioner visits per month were 71% with four or more visits, 17% with two to three visits, 4% with one visit, and 8% with no visits. Each 10% absolute greater proportion of patients seen by their nephrology practitioner(s) four or more times per month was associated with a modestly but statistically significant lower score of patient experience with nephrologist care by -0.3 points (95% confidence interval, -0.5 to -0.1) and no effect on experience with other domains of dialysis care.
In an analysis of patient experiences at the dialysis facility level, frequent nephrology practitioner visits to facilities where patients undergo outpatient hemodialysis were not associated with better patient experiences.
推进美国肾脏健康倡议带来的新付费模式可能会促使肾病医生减少面对面的中心血液透析就诊次数。本研究旨在了解更频繁的肾病医生透析就诊是否能改善患者体验，并为未来的政策提供信息。
设计、地点、参与者和测量方法：在一项横断面研究中，我们对 2015 年 4 月 1 日至 2016 年 1 月 31 日期间接受透析治疗的患者进行了研究，将全国肾脏衰竭登记处的患者记录与来自中心血液透析医疗保健提供者和系统评估调查的患者体验数据相联系。我们使用多变量混合效应线性回归模型来研究肾病医生就诊频率与患者报告的肾病医生护理体验之间的关联。
在 5125 家美国透析机构中，有 2981 家（58%）机构在 2015 年 4 月至 2016 年 1 月期间完成了至少 30 次中心血液透析医疗保健提供者和系统评估调查，在这些机构中接受治疗的 243324 名患者拥有医疗保险 A/B 部分的覆盖范围。每月的面对面医生就诊次数中，有 71%的患者就诊次数为 4 次或更多次，17%的患者就诊次数为 2-3 次，4%的患者就诊次数为 1 次，8%的患者无就诊。每月每增加 10%的患者接受他们的肾病医生（们）4 次或更多次就诊，患者对肾病医生护理的体验评分会适度但显著地降低 0.3 分（95%置信区间：-0.5 至-0.1），对其他透析护理领域的体验没有影响。
在对透析机构层面的患者体验进行分析时，频繁的肾病医生到接受门诊血液透析治疗的患者所在机构就诊与更好的患者体验无关。
