Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system
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.
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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.
Posted 07 Jan, 2021
On 01 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 01 Nov, 2020
Received 14 Oct, 2020
Received 07 Oct, 2020
On 30 Sep, 2020
On 02 Sep, 2020
Invitations sent on 20 Aug, 2020
On 10 Aug, 2020
On 09 Aug, 2020
On 09 Aug, 2020
On 07 Aug, 2020
Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system
Posted 07 Jan, 2021
On 01 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 01 Nov, 2020
Received 14 Oct, 2020
Received 07 Oct, 2020
On 30 Sep, 2020
On 02 Sep, 2020
Invitations sent on 20 Aug, 2020
On 10 Aug, 2020
On 09 Aug, 2020
On 09 Aug, 2020
On 07 Aug, 2020
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.
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