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Research article
Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system
Nicholas S. Roetker
Hennepin Healthcare Research Institute
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5386-3289
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Nephrology.
Background: We investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients.
Methods: Using quarterly, period prevalent cohorts of patients undergoing maintenance HD with a catheter in the US Renal Data System (2008-2015), we studied rates of claims for within- and outside-HD-unit thrombolytic use, and thrombus/fibrin sheath removal, and rates of delayed HD treatment after ESRD PPS implementation, January 1, 2011. Associations between PPS implementation and change in trend of rates of each outcome were assessed using covariate-adjusted Poisson regression, using a piecewise linear function for quarter-time (with breakpoint at PPS implementation).
Results: Among an average of 69,428 quarterly catheter users, rates of claims for within-HD-unit thrombolytic use declined from 236.6 (Q1-2008) to 81.4 (Q4-2012) per 100 person-years ( P < 0.0001, PPS association with change in trend); rates of claims for thrombus/fibrin sheath removal procedures increased from 3.9 (Q1-2008) to 8.8 (Q3-2015) per 100 person-years ( P = 0.0001, PPS association with change in trend). Rates of delayed HD treatment increased from 1.6 (Q2-2008) to 2.3 (Q3-2015) per patient-quarter, although PPS implementation was associated with a decrease in this rising trend (1.6% increase per quarter pre-PPS, 1.2% post-PPS; P < 0.0001, change in trend).
Conclusions: After PPS implementation, thrombolytic use decreased and thrombus/fibrin sheath removal increased. The increasing trend in delayed HD treatment appeared to slow after PPS implementation, but delayed sessions continued to increase year over year for unclear reasons.
Keywords
Dialysis bundled payment, end-stage renal disease, vascular access management
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- RoetkerPPSandHDcathetermanagementAdditionalFileR1.pdf
Additional File Table S1. Administrative codes used to identify catheter use for hemodialysis. Additional File Table S2. Administrative codes used to identify catheter management-related events. Additional File Table S3. ICD-9-CM codes used to define the comorbid conditions comprising the Liu comorbidity index. Additional File Figure S1. Construction of the quarterly cohorts (presenting only the first cohort in each year). HD, hemodialysis. Additional File Figure S2. Quarterly mean total Medicare costs in the 7-day period starting from the date of each claim for thrombolytic use, separately for (a) within-HD-unit and (b) outside-HD-unit administrations. Costs are presented with 95% confidence intervals and are standardized for age, sex, race, dual eligibility, primary cause of ESRD, ESRD duration, and Liu comorbidity index (using Q1-2011 as the reference). CI, confidence interval; ESRD, end-stage renal disease, PPS, prospective payment system. Additional File Figure S3. Quarterly mean total Medicare costs in the 7-day period starting from the date of each claim for a thrombus/fibrin sheath removal procedure. Costs are presented with 95% confidence intervals and are standardized for age, sex, race, dual eligibility, primary cause of ESRD, ESRD duration, and Liu comorbidity index (using Q1-2011 as the reference). CI, confidence interval; ESRD, end-stage renal disease, PPS, prospective payment system.
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On 01 Dec, 2020
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Editorial decision: Major revision
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Received 14 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Reviewer #2 agreed
On 30 Sep, 2020
Reviewer #1 agreed
On 02 Sep, 2020
Reviewers invited
Invitations sent on 20 Aug, 2020
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On 10 Aug, 2020
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On 09 Aug, 2020
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Subject Areas
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This preprint is under consideration at BMC Nephrology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system
Nicholas S. Roetker
Hennepin Healthcare Research Institute
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5386-3289
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 07 Jan, 2021
No comments provided
Editor assigned
On 01 Dec, 2020
Submission checks complete
On 01 Dec, 2020
Editor invited
On 01 Dec, 2020
No comments provided
Editorial decision: Major revision
On 01 Nov, 2020
Review #2 received
Received 14 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Reviewer #2 agreed
On 30 Sep, 2020
Reviewer #1 agreed
On 02 Sep, 2020
Reviewers invited
Invitations sent on 20 Aug, 2020
Editor assigned
On 10 Aug, 2020
Submission checks complete
On 09 Aug, 2020
Editor invited
On 09 Aug, 2020
First submitted
On 07 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Nephrology.
Background: We investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients.
Methods: Using quarterly, period prevalent cohorts of patients undergoing maintenance HD with a catheter in the US Renal Data System (2008-2015), we studied rates of claims for within- and outside-HD-unit thrombolytic use, and thrombus/fibrin sheath removal, and rates of delayed HD treatment after ESRD PPS implementation, January 1, 2011. Associations between PPS implementation and change in trend of rates of each outcome were assessed using covariate-adjusted Poisson regression, using a piecewise linear function for quarter-time (with breakpoint at PPS implementation).
Results: Among an average of 69,428 quarterly catheter users, rates of claims for within-HD-unit thrombolytic use declined from 236.6 (Q1-2008) to 81.4 (Q4-2012) per 100 person-years ( P < 0.0001, PPS association with change in trend); rates of claims for thrombus/fibrin sheath removal procedures increased from 3.9 (Q1-2008) to 8.8 (Q3-2015) per 100 person-years ( P = 0.0001, PPS association with change in trend). Rates of delayed HD treatment increased from 1.6 (Q2-2008) to 2.3 (Q3-2015) per patient-quarter, although PPS implementation was associated with a decrease in this rising trend (1.6% increase per quarter pre-PPS, 1.2% post-PPS; P < 0.0001, change in trend).
Conclusions: After PPS implementation, thrombolytic use decreased and thrombus/fibrin sheath removal increased. The increasing trend in delayed HD treatment appeared to slow after PPS implementation, but delayed sessions continued to increase year over year for unclear reasons.
Figure 1
Figure 2
Figure 3