Association of the Comprehensive ESRD Care Model with Treatment Adherence

Area of Science:

• Nephrology
• Health Services Research
• Health Economics

Background:

• Poor adherence to dialysis treatments leads to adverse clinical and economic outcomes.
• The Comprehensive ESRD Care (CEC) Model, a modification of the Accountable Care Organization framework, was launched in 2015.
• CEC Model participants focused on increasing dialysis adherence and rescheduling missed treatments.

Purpose of the Study:

• To evaluate the impact of the CEC Model on dialysis treatment adherence.
• To assess the effectiveness of CEC Model strategies in improving patient compliance with scheduled dialysis sessions.
• To analyze the association between the CEC Model and the rescheduling of missed dialysis treatments.

Main Methods:

• Utilized Medicare databases from 2014-2019.
• Employed difference-in-differences models to compare adherence in CEC facilities versus matched comparison facilities.
• Defined skipped and rescheduled treatments based on patient service dates and hospitalization status.

Main Results:

• Patients in the CEC Model showed higher odds of attending as-scheduled sessions (OR, 1.02; P=0.08), with stronger effects in females and younger patients (<70 years).
• The CEC Model was associated with significantly higher odds of rescheduled sessions (OR, 1.09; P<0.001), particularly among males and younger patients.
• While effects were observed, the absolute magnitudes of the improvements in adherence and rescheduling were modest.

Conclusions:

• The CEC Model incentivizes strategies to prevent costly interventions and improve patient outcomes.
• CEC Model participants' focus on adherence and rescheduling appears to be a successful strategy.
• The study suggests that the CEC Model contributes to better dialysis adherence, though effects are modest.