Relationship among length of facility ownership, clinical performance, and mortality

The association between level of performance in achieving guideline-recommended clinical indicators and relative reduction in patient mortality is inconsistent among large dialysis organizations (LDOs). Because growth rates among providers differ, we reasoned that clinical performance and mortality rates in dialysis facilities may be related to length of facility ownership.

We examined achievement of clinical performance indicators among prevalent long-term hemodialysis patients who were enrolled in cohorts of DaVita facilities between December 2005 and December 2007. We compared results in 606 facilities owned before December 1, 2004 (existing), with those seen in 504 facilities that were acquired in October 2005 (newly acquired).

At baseline, existing compared with newly acquired DaVita facilities showed higher levels of clinical performance and lower patient mortality. These differences persisted up to 2 years for selected outcomes, including dialysis adequacy and anemia management. Substantial improvement was seen in both cohorts for mineral bone disease outcomes; however, 2 years after acquisition, between-cohort differences in relative risk for death were no longer discernible.

These findings confirm that intervention to improve quality outcomes in dialysis facilities produces direct benefits that are tangible to patients. Our results also provide new evidence that length of ownership may be a significant factor in determining facility performance within a large dialysis organization.