Impact of the End Stage Renal Disease Prospective Payment System on the Use of Peritoneal Dialysis.
Impact of the End Stage Renal Disease Prospective Payment System on the Use of Peritoneal Dialysis.
复制标题
终末期肾病前瞻性支付系统对腹膜透析使用的影响。
DOI：
10.1016/j.ekir.2016.12.004
复制
发表时间：
2017
影响因子：
6
通讯作者：
Zhang,Yi
中科院分区：
文献类型：
--
作者：
Zhang,Qian;Thamer,Mae;Kshirsagar,Onkar;Zhang,Yi
IntroductionThe End Stage Renal Disease (ESRD) Prospective Payment System (PPS), implemented by the Centers for Medicare and Medicaid Services in January 2011, encouraged use of peritoneal dialysis (PD) through various financial incentives. Our goal was to determine whether PPS effectively increased PD use in incident dialysis patients.MethodsOur study used the United States Renal Data System (USRDS) to identify 430,927 adult patients who initiated dialysis between 2009 and 2012. The interrupted time series method was used to evaluate the association Centers for Medicare and Medicaid Services of PPS with PD use at dialysis initiation. We further stratified by patient demographics, predialysis care, and facility chain and profit status.ResultsInterrupted time series analysis indicated PPS was associated with increased PD use in the 2-year period after PPS (change in slope = 0.04,P< 0.0001), although there was no immediate change in the level of PD use at the beginning of PPS (P= 0.512). Stratified analyses indicated PPS led to increased PD use across all age, race, and sex groups (P< 0.05) although marginally among females (P= 0.09). Notably, small dialysis organizations and nonprofit organizations appeared to increase use of PD faster compared to large dialysis organizations and for-profit units, respectively.DiscussionImplementation of the Centers for Medicare and Medicaid Services ESRD payment reform was associated with an increased use of PD in the 2 years after PPS. Our findings highlight the role of financial incentives in changing practice patterns to increase use of a dialysis modality considered to be both more cost-effective and empowering to ESRD patients. However, even after PPS, rates of PD use remain low among the dialysis population in the USA.
