Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Campus Box 104427, Durham, NC 27710. Email:
Am J Manag Care. 2023 Mar;29(3):152-158. doi: 10.37765/ajmc.2023.89329.
The Medicare end-stage kidney disease (ESKD) prospective payment system (PPS) for maintenance dialysis, implemented in 2011, resulted in modestly increased access to both home-based peritoneal dialysis (PD) and home hemodialysis (HHD) treatment modalities, but it is unclear whether regional disparities in home dialysis (PD and HHD) were affected. We compared regional home dialysis use by White and non-White individuals over time.
Retrospective cohort study of dialysis facilities offering home dialysis in 2006-2016 and of 1,098,579 patients with prevalent ESKD in 2006-2016.
We compared hospital referral region (HRR) utilization rates of home dialysis between White and non-White patients over time using a generalized estimating equation model with a negative binomial distribution adjusting for regional characteristics.
The mean number of facilities offering home dialysis operating in each HRR increased from 15.6 in 2006 to 22.1 in 2016. Observed mean HRR home dialysis rates increased overall, but White patients maintained greater home dialysis use than non-White patients: 19.7% in 2006 and 26.2% in 2016 among White patients vs 13.0% in 2006 and 17.8% in 2016 among non-White patients. In adjusted analysis, there was no evidence of changes in White/non-White disparities in home dialysis use over time (P = .84) or after the Medicare ESKD PPS in 2011 (incidence rate ratio, 0.97; 95% CI, 0.92-1.02; P = .29).
Even after modest increases in dialysis facility availability and patient utilization after the implementation of the Medicare ESKD PPS in 2011, significant racial disparities in home dialysis remain.
2011 年实施的医疗保险终末期肾病（ESKD）维持性透析预付制（PPS），使家庭为基础的腹膜透析（PD）和家庭血液透析（HHD）治疗方式的获得略有增加，但尚不清楚医疗保险 ESKD PPS 是否影响了家庭透析（PD 和 HHD）的区域差异。我们比较了不同种族的个体在不同时期的家庭透析（PD 和 HHD）使用情况。
对 2006 年至 2016 年期间提供家庭透析的透析机构以及 2006 年至 2016 年期间 1098579 例现患 ESKD 患者进行回顾性队列研究。
我们使用负二项分布广义估计方程模型，在调整了区域特征的情况下，比较了不同种族患者的家庭透析医院转诊区域（HRR）使用率随时间的变化情况。
每个 HRR 开展家庭透析的机构数量从 2006 年的 15.6 家增加到 2016 年的 22.1 家。总体上，观察到的 HRR 家庭透析率呈上升趋势，但白人患者的家庭透析使用率仍然高于非白人患者：2006 年白人患者为 19.7%，2016 年为 26.2%，而非白人患者则分别为 2006 年的 13.0%和 2016 年的 17.8%。在调整分析中，在 Medicare ESKD PPS 于 2011 年实施后，并未发现家庭透析使用的种族差异有变化的迹象（P=0.84）。
即使在 Medicare ESKD PPS 于 2011 年实施后，透析机构的可用性和患者利用率都有所增加，但家庭透析的种族差异仍然很大。
