Suzuki Yasunori, Iwagami Masao, Shimizu Sayuri, Goto Atsushi
Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan.
Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Clin Kidney J. 2024 Nov 18;17(12):sfae342. doi: 10.1093/ckj/sfae342. eCollection 2024 Dec.
Peripheral arterial disease (PAD) occurs frequently in patients undergoing dialysis, but early intervention for PAD may not be fully implemented. We evaluated the effects of financially incentivising dialysis facilities that provided early detection and management of PAD on outcomes of PAD care.
This retrospective cohort study identified patients aged 18-74 years who received maintenance haemodialysis between April 2016 and March 2021 from the JMDC Claims Database. The (time-dependent) exposure was claim for incentives for early detection and management of PAD. The outcomes were PAD screening tests (process indicator) and infections, revascularisation procedures, and amputations in the lower extremities (outcome indicators). We used Poisson regression models with generalised estimation equations for the number of screening tests and Cox proportional hazards models for the first incidence of the outcome indicator.
Overall, 5850 patients on haemodialysis were identified: 5183 and 667 with and without claims for the incentive, respectively; the numbers of screening tests were 9070 and 776, respectively (adjusted ratio of the frequency, 1.89 [95% confidence interval 1.70-2.10]). Among patients with and without claims for the incentive, infections occurred in 479 and 109 (adjusted hazard ratio [HR], 0.99 [0.80-1.23]), revascularisations were performed in 192 and 29 (adjusted HR, 1.11 [0.75-1.66]), and amputations were conducted in 72 and 9 patients, respectively (adjusted HR, 1.35 [0.66-2.75]).
The financial incentive for early detection and management of PAD was associated with a higher frequency of PAD screening tests, but not with improved outcome indicators.
外周动脉疾病（PAD）在接受透析的患者中频繁发生，但对PAD的早期干预可能未得到充分实施。我们评估了对提供PAD早期检测和管理的透析机构给予经济激励对PAD护理结局的影响。
这项回顾性队列研究从JMDC索赔数据库中识别出2016年4月至2021年3月期间接受维持性血液透析的18 - 74岁患者。（随时间变化的）暴露因素是对PAD早期检测和管理的激励索赔。结局指标包括PAD筛查测试（过程指标）以及下肢感染、血运重建手术和截肢（结局指标）。我们使用泊松回归模型和广义估计方程来分析筛查测试的次数，并使用Cox比例风险模型来分析结局指标的首次发生率。
总体而言，共识别出5850例血液透析患者：分别有5183例和667例有和没有激励索赔；筛查测试次数分别为9070次和776次（频率调整比为1.89 [95%置信区间1.70 - 2.10]）。在有和没有激励索赔的患者中，感染分别发生479例和109例（调整后风险比[HR]为0.99 [0.80 - 1.23]），血运重建手术分别进行192例和29例（调整后HR为1.11 [0.75 - 1.66]），截肢分别进行72例和9例（调整后HR为1.35 [0.66 - 2.75]）。
对PAD早期检测和管理的经济激励与更高频率的PAD筛查测试相关，但与改善结局指标无关。
