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Have racial disparities in home dialysis utilization changed over time?
Virginia Wang1, Lindsay Zepel, Cynthia J Coffman
1Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Campus Box 104427, Durham, NC 27710.
The American Journal of Managed Care
|March 22, 2023
Summary
The Medicare payment system for end-stage kidney disease (ESKD) increased home dialysis use but did not reduce racial disparities. Significant racial gaps in home dialysis access persist despite increased facility availability.
Area of Science:
- Nephrology
- Public Health
- Health Services Research
Background:
- The Medicare End-Stage Kidney Disease Prospective Payment System (PPS) aimed to improve dialysis access.
- Home dialysis modalities, including peritoneal dialysis (PD) and home hemodialysis (HHD), offer patient benefits but access varies.
- Understanding the impact of the ESKD PPS on racial disparities in home dialysis is crucial.
Purpose of the Study:
- To assess the effect of the Medicare ESKD PPS on regional disparities in home dialysis utilization between White and non-White patients.
- To analyze trends in home dialysis access across different racial groups before and after the 2011 PPS implementation.
Main Methods:
- Retrospective cohort study analyzing data from 2006-2016 for over 1 million patients with ESKD.
- Compared home dialysis utilization rates between White and non-White patients across hospital referral regions (HRRs).
- Utilized generalized estimating equation models to adjust for regional characteristics and assess changes over time.
Main Results:
- The number of facilities offering home dialysis increased significantly between 2006 and 2016.
- Overall home dialysis rates increased, but White patients consistently had higher utilization than non-White patients.
- Adjusted analyses showed no significant change in racial disparities in home dialysis use over time or after the ESKD PPS implementation.
Conclusions:
- Despite increased availability and use of home dialysis post-PPS, significant racial disparities persist.
- The Medicare ESKD PPS did not effectively reduce existing racial inequities in home dialysis access.
- Further interventions are needed to address and eliminate racial disparities in end-stage kidney disease treatment modalities.
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