A View of the Bundle from a Home Dialysis Perspective

Golper, Thomas A.

doi:10.2215/cjn.04570417

Cited by 11 publications

(3 citation statements)

References 9 publications

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“…As shown in Figure 1, the environmental tapestry influencing dialysis modality distribution is much more complex than simply government policy or reimbursement. Even within the United States example of financial incentives increasing PD use, Golper has argued that this increase occurred on the background of rising PD numbers after years of educational efforts aimed at patients and nephrologists (10). His analysis also includes more recent years with a slowing down in the increase of PD numbers after implementation of the financial incentive that was caused by a shortage of PD fluid in 2013, as the manufacturers had not increased supply sufficiently to meet the demand.…”

Section: Staffing Costsmentioning

confidence: 99%

Influence of Reimbursement Policies on Dialysis Modality Distribution around the World

Brown¹

2018

CJASN

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Section: Staffing Costsmentioning

confidence: 99%

Influence of Reimbursement Policies on Dialysis Modality Distribution around the World

Brown¹

2018

CJASN

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“…Considering that home modalities of dialysis provide equivalent survival and trends for better patient-centered outcomes at a significantly lower healthcare cost (relative to in-center dialysis) [2][3][4][5][6][7], overwhelming use of in-center dialysis for the management of ESKD in the US has been a concern for over two decades. Thus, most stakeholders in ESKD, including the Center for Medicare and Medicaid Services have repeatedly advocated for increasing informed home dialysis utilization for the management ESKD [8,9].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of an end stage kidney disease awareness survey: Item difficulty and discrimination indices

et al. 2022

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Introduction Lack of awareness for chronic kidney disease (CKD), including end stage kidney disease (ESKD) and their management options is a major impediment to patients being able to select and use home dialysis therapies. While some instruments have been developed to measure CKD awareness, we lack validated instruments to evaluate patients’ awareness of ESKD and dialysis modalities. This study is part of multipart project for developing and validating an ESKD-centric disease awareness questionnaire. Methods A team of specialty renal care experts developed a 45-items questionnaire encompassing the subdomains of General Kidney Knowledge, CKD Knowledge, and ESKD Knowledge. Item reduction analysis—specifically, calculation of item difficulty and item discrimination index scores—was used to items for further review and potential removal. Results Index scores were reviewed in conjunction with consideration of theoretical and substantive item content to reduce the number of items in the questionnaire, resulting in a 32-item questionnaire, retaining 5/10 items in the general kidney knowledge subdomain, 14/21 items in the CKD knowledge subdomain, and 13/14 items in the ESKD knowledge subdomain. Retained items ranged from 0.19 to 0.79 on the difficulty index, and from 0.31 to 0.81 on the discrimination index. Scores for percent correct on the reduced questionnaire spanned 0% to 87.5% correct on the full scale, 0% to 100% correct on the General Knowledge subdomain, 0% to 100% on the CKD Knowledge subdomain, and 0% to 92.3% on ESKD Knowledge subdomain. Conclusions The questionnaire developed and refined in this study constitutes a patient disease awareness instrument that spans a range of difficulty, and yet shows strong ability to distinguish between patients with varying levels of disease awareness. This study is the first in part of a multistep project to addresses a gap in measuring ESKD specific knowledge. Accurate assessment of patients’ disease awareness through a validated instrument can allow identification of knowledge domains leading to positive impacts on their healthcare decisions and improve targeted patient education efforts.

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“…7 Over the last two decades, major ESRD stakeholders have consistently advocated, and the Center for Medicare and Medicaid Services (CMS) has targeted policies to facilitate greater home dialysis use. 8 Unfortunately, these efforts have resulted in marginal increase in home dialysis rates and 90.0% of the US ESRD patients continue to receive in-center hemodialysis. 9 In July 2019, the US president issued an executive order, emphasizing the goals for increasing the home dialysis utilization for the management of ESRD in the United States.…”

Section: Introductionmentioning

confidence: 99%

Utilization of CMS pre-ESRD Kidney Disease Education services and its associations with the home dialysis therapies

et al. 2020

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Background: Kidney Disease Education (KDE) has been shown to improve informed dialysis selection and home dialysis use, two long-held but underachieved goals of US nephrology community. In 2010, the Center for Medicare and Medicaid Services launched a policy of KDE reimbursements for all Medicare beneficiaries with advanced chronic kidney disease. However, the incorporation of KDE service in real-world practice and its association with the home dialysis utilization has not been examined. Methods: Using the 2016 US Renal Data System linked to end-stage renal disease (ESRD) and pre-ESRD Medicare claim data, we identified all adult incident ESRD patients with active Medicare benefits at their first-ever dialysis during the study period (1 January 2010 to 31 December 2014). From these, we identified those who had at least one KDE service code before their dialysis initiation (KDE cohort) and compared them to a parsimoniously matched non-KDE control cohort in 1:4 proportions for age, gender, ESRD network, and the year of dialysis initiation. The primary outcome was home dialysis use at dialysis initiation, and secondary outcomes were home dialysis use at day 90 and anytime through the course of ESRD. Results: Of the 369,968 qualifying incident ESRD Medicare beneficiaries with their first-ever dialysis during the study period, 3469 (0.9%) received KDE services before dialysis initiation. African American race, Hispanic ethnicity, and the presence of congestive heart failure and hypoalbuminemia were associated with significantly lower odds of receiving KDE services. Multivariate analyses showed that KDE recipients had twice the odds of initiating dialysis with home modalities (15.0% vs. 6.9%; adjusted odds ratio (aOR):95% confidence interval (CI) 2.0:1.7–2.4) and had significantly higher odds using home dialysis throughout the course of ESRD (home dialysis use at day 90 (17.6% vs. 9.9%, aOR:CI 1.7:1.4–1.9) and cumulatively (24.7% vs. 15.1%, aOR:CI 1.7:1.5–1.9)). Conclusions: Utilization of pre-ESRD KDE services is associated with significantly greater home dialysis utilization in the incident ESRD Medicare beneficiaries. The very low rates of utilization of these services suggest the need for focused systemic evaluations to identify and address the barriers and facilitators of this important patient-centered endeavor.

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A View of the Bundle from a Home Dialysis Perspective

Cited by 11 publications

References 9 publications

Influence of Reimbursement Policies on Dialysis Modality Distribution around the World

Influence of Reimbursement Policies on Dialysis Modality Distribution around the World

Development and validation of an end stage kidney disease awareness survey: Item difficulty and discrimination indices

Utilization of CMS pre-ESRD Kidney Disease Education services and its associations with the home dialysis therapies

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