Kevin F Erickson1, Matthew W Mell2, Wolfgang C Winkelmayer3, Glenn M Chertow4, Jay Bhattacharya5. 1. Division of Nephrology, Department of Medicine, Center for Primary Care and Outcomes Research, Department of Medicine, and kevine1@stanford.edu. 2. Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California; and. 3. Section of Nephrology, Baylor College of Medicine, Houston, Texas. 4. Division of Nephrology, Department of Medicine. 5. Center for Primary Care and Outcomes Research, Department of Medicine, and.
Abstract
BACKGROUND AND OBJECTIVES: Medicare reimbursement policy encourages frequent provider visits to patients with ESRD undergoing hemodialysis. This study sought to determine whether more frequent face-to-face provider (physician and advanced practitioner) visits lead to more procedures and therapeutic interventions aimed at preserving arteriovenous fistulas and grafts, improved vascular access outcomes, and fewer related hospitalizations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Multivariable regression was used to evaluate the association between provider (physician and advanced practitioner) visit frequency and interventions aimed at preserving vascular access, vascular access survival, hospitalization for vascular access infection, and outpatient antibiotic use in a cohort of 63,488 Medicare beneficiaries receiving hemodialysis in the United States. Medicare claims were used to identify the type of vascular access used, access-related events, and vascular access failure. RESULTS: One additional provider (physician and advanced practitioner) visit per month was associated with a 13% higher odds of receiving an intervention to preserve vascular access (95% confidence interval [95% CI], 12% to 14%) but was not associated with vascular access survival (hazard ratio, 1.01; 95% CI, 0.99 to 1.03). One additional provider visit was associated with a 9% (95% CI, 5% to 14%) lower odds of hospitalization for vascular access infection and a corresponding 9% (95% CI, 5% to 14%) higher odds of outpatient intravenous antibiotic administration. However, the associated changes in absolute probabilities of hospitalization and antibiotic administration were small. CONCLUSIONS: More frequent face-to-face provider (physician and advanced practitioner) visits were associated with more procedures and therapeutic interventions aimed at preserving vascular accesses, but not with prolonged vascular access survival and only a small decrease in hospitalization for vascular access.
BACKGROUND AND OBJECTIVES: Medicare reimbursement policy encourages frequent provider visits to patients with ESRD undergoing hemodialysis. This study sought to determine whether more frequent face-to-face provider (physician and advanced practitioner) visits lead to more procedures and therapeutic interventions aimed at preserving arteriovenous fistulas and grafts, improved vascular access outcomes, and fewer related hospitalizations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Multivariable regression was used to evaluate the association between provider (physician and advanced practitioner) visit frequency and interventions aimed at preserving vascular access, vascular access survival, hospitalization for vascular access infection, and outpatient antibiotic use in a cohort of 63,488 Medicare beneficiaries receiving hemodialysis in the United States. Medicare claims were used to identify the type of vascular access used, access-related events, and vascular access failure. RESULTS: One additional provider (physician and advanced practitioner) visit per month was associated with a 13% higher odds of receiving an intervention to preserve vascular access (95% confidence interval [95% CI], 12% to 14%) but was not associated with vascular access survival (hazard ratio, 1.01; 95% CI, 0.99 to 1.03). One additional provider visit was associated with a 9% (95% CI, 5% to 14%) lower odds of hospitalization for vascular access infection and a corresponding 9% (95% CI, 5% to 14%) higher odds of outpatient intravenous antibiotic administration. However, the associated changes in absolute probabilities of hospitalization and antibiotic administration were small. CONCLUSIONS: More frequent face-to-face provider (physician and advanced practitioner) visits were associated with more procedures and therapeutic interventions aimed at preserving vascular accesses, but not with prolonged vascular access survival and only a small decrease in hospitalization for vascular access.
Authors: Kevin F Erickson; Kelvin B Tan; Wolfgang C Winkelmayer; Glenn M Chertow; Jay Bhattacharya Journal: Clin J Am Soc Nephrol Date: 2013-02-21 Impact factor: 8.237
Authors: Evelyn K Mentari; Peter B DeOreo; Andrew S O'Connor; Thomas E Love; Edmond S Ricanati; Ashwini R Sehgal Journal: Am J Kidney Dis Date: 2005-10 Impact factor: 8.860
Authors: Takehiko Kawaguchi; Angelo Karaboyas; Bruce M Robinson; Yun Li; Shunichi Fukuhara; Brian A Bieber; Hugh C Rayner; Vittorio E Andreucci; Ronald L Pisoni; Friedrich K Port; Hal Morgenstern; Tadao Akizawa; Rajiv Saran Journal: J Am Soc Nephrol Date: 2013-07-25 Impact factor: 10.121
Authors: Elliott S Fisher; David E Wennberg; Thérèse A Stukel; Daniel J Gottlieb; F L Lucas; Etoile L Pinder Journal: Ann Intern Med Date: 2003-02-18 Impact factor: 25.391
Authors: Louise M Moist; David N Churchill; Andrew A House; Steven F Millward; James E Elliott; Stewart W Kribs; William J DeYoung; Lesley Blythe; Lawrence W Stitt; Robert M Lindsay Journal: J Am Soc Nephrol Date: 2003-10 Impact factor: 10.121
Authors: Samuel A Silver; Sarah E Bota; Eric McArthur; Kristin K Clemens; Ziv Harel; Kyla L Naylor; Manish M Sood; Amit X Garg; Ron Wald Journal: Clin J Am Soc Nephrol Date: 2020-03-05 Impact factor: 8.237
Authors: Brian M Brady; Bo Zhao; Bich N Dang; Wolfgang C Winkelmayer; Glenn M Chertow; Kevin F Erickson Journal: Clin J Am Soc Nephrol Date: 2021-07-12 Impact factor: 10.614