NDLI: Variation in nephrologist visits to patients on hemodialysis across dialysis facilities and geographic locations.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Erickson, Kevin F. Tan, Kelvin B. Winkelmayer, Wolfgang C. Chertow, Glenn M. Bhattacharya, Jay
Spatial Coverage	United States
Description	Country affiliation: United States Author Affiliation: Erickson KF ( Department of Nephrology, Stanford University School of Medicine, Palo Alto, California 94304, USA. kevine1@stanford.edu)
Abstract	BACKGROUND AND OBJECTIVES: Geographic and other variations in medical practices lead to differences in medical costs, often without a clear link to health outcomes. This work examined variation in the frequency of physician visits to patients receiving hemodialysis to measure the relative importance of provider practice patterns (including those patterns linked to geographic region) and patient health in determining visit frequency. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This work analyzed a nationally representative 2006 database of patients receiving hemodialysis in the United States. A variation decomposition analysis of the relative importance of facility, geographic region, and patient characteristics--including demographics, socioeconomic status, and indicators of health status--in explaining physician visit frequency variation was conducted. Finally, the associations between facility, geographic and patient characteristics, and provider visit frequency were measured using multivariable regression. RESULTS: Patient characteristics accounted for only 0.9% of the total visit frequency variation. Accounting for case-mix differences, patients' hemodialysis facilities explained about 24.9% of visit frequency variation, of which 9.3% was explained by geographic region. Visit frequency was more closely associated with many facility and geographic characteristics than indicators of health status. More recent dialysis initiation and recent hospitalization were associated with decreased visit frequency. CONCLUSIONS: In hemodialysis, provider visit frequency depends more on geography and facility location and characteristics than patients' health status or acuity of illness. The magnitude of variation unrelated to patient health suggests that provider visit frequency practices do not reflect optimal management of patients on dialysis.
File Format	HTM / HTML
ISSN	15559041
e-ISSN	1555905X
DOI	10.2215/CJN.10171012
Journal	Clinical Journal of the American Society of Nephrology
Issue Number	6
Volume Number	8
Language	English
Publisher	American Society of Nephrology
Publisher Date	2013-06-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Research Support, N.i.h., Extramural Therapy Residence Characteristics Multivariate Analysis Nephrology Comparative Study Epidemiology Physician's Practice Patterns Physician-patient Relations Diagnosis Odds Ratio Discipline Nephrology Logistic Models Ambulatory Care Facilities Healthcare Disparities Kidney Failure, Chronic Statistics & Numerical Data Health Status Renal Dialysis
Content Type	Text
Resource Type	Article
Subject	Transplantation Critical Care and Intensive Care Medicine Nephrology Epidemiology

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