Organizational status of dialysis facilities and patient outcome: does higher injectable medication use mediate increased mortality?
Organizational status of dialysis facilities and patient outcome: does higher injectable medication use mediate increased mortality?
复制标题
透析设施的组织状况和患者结果：注射药物使用量增加是否会导致死亡率增加？
DOI：
10.1111/1475-6773.12019
复制
发表时间：
2013
影响因子：
3.4
通讯作者：
Cotter,DennisJ
中科院分区：
文献类型：
--
作者：
Zhang,Yi;Thamer,Mae;Kshirsagar,Onkar;Cotter,DennisJ
ObjectiveExamine the mediating effect of injectable drugs in the relationship between dialysis facility organizational status and patient mortality.Study SettingMedicare dialysis population.Study DesignData from the U.S. Renal Data System (USRDS) were used to identify 3,884 freestanding dialysis facilities and 37,942 Medicare patients incident to end‐stage renal disease (ESRD) in 2006. The role of injectable medications was evaluated during a 2‐year follow‐up period by mediational analyses using mixed‐effect regression models.Data CollectionUSRDS data were matched with Dialysis Facility Report data from Centers for Medicare and Medicaid Services (CMS) and census data.Principal FindingsThere was a strong association found between organizational status and use of injectable drugs. Large for‐profit chains used significantly higher injectable medications compared with nonprofit chains and independent facilities. However, the relationship between facility organizational status and patient mortality was not found to be mediated through the higher use of injectable drugs.ConclusionsLarge for‐profit chain facilities administered higher IV epoetin, iron, and vitamin D dosages, but this did not result in improved survival. Given the associated costs and lack of a survival benefit, the overuse of injectable medications among the U.S. dialysis patients will likely end under the recent bundling of injectable medications without jeopardizing patient outcomes.
