Geographic information systems and chronic kidney disease: racial disparities, rural residence and forecasting

Rodriguez, Rudolph A.; Hotchkiss, John R.; O’Hare, Ann M.

doi:10.5301/jn.5000225

Cited by 35 publications

(30 citation statements)

References 64 publications

(66 reference statements)

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“…Compared with urban patients, rural patients have less access to dialysis units and home dialysis therapies as well (20). Erikson and colleagues confirmed that geographic location was associated with less frequent patient visits by dialysis providers, which may be due to many reasons, such as fewer nephrologists in rural areas, difficulty with access to dialysis units, and distance to dialysis units.…”

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confidence: 75%

Geography and ESRD Care

Young

2013

Clinical Journal of the American Society of Nephrology

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In 2004, the Centers for Medicare and Medicaid Services (CMS) made a landmark change in the way nephrologists were reimbursed for outpatient dialysis visits for the first time in over 30 years. The Final Rule, as it was called, changed reimbursement for dialysis outpatient assessment from a capitated monthly visit to a graded reimbursement based on the number of times per month a patient was seen in the outpatient setting. These ESRD-related visits, defined by the new "G codes," allow for reimbursement for 1 visit, 2-3 visits, or $4 visits per month. Visits must be provided face to face by a nephrologist or other provider and can occur in the dialysis unit or other outpatient settings (1). Before the Final Rule, much discussion occurred among dialysis providers, nephrologists, and nephrology practices because of concerns that acceptance of this rule would have adverse effects on ESRD patient care due to increased requirements for dialysis unit rounding.Before the ruling, little was known regarding the association of frequency of dialysis rounding and outcomes. Several observational studies reported that increased frequency of dialysis patient visits by nephrologists was associated with several positive outcomes, including achievement of some clinical performance targets (albumin and dialysis adequacy [Kt/V], and total number of improved performance measures) (2), satisfaction with the nephrologist, and patient adherence (3). However, increased frequency was not associated with improved short-term outcomes such as fewer hospitalizations, better quality of life, or overall satisfaction with care (3). Conversely, increased frequency of "sit-down" team rounds with nursing staff, social workers, and nutritionists in the dialysis unit was associated with better clinical performance measures (albumin level), fewer hospitalizations (incidence rate ratio, 0.68; 95% confidence interval [95% CI], 0.51 to 0.91), decreased number of hospital days, and improved survival (hazard ratio, 0.71; 95% CI, 0.53 to 0.95) compared with units with fewer reported sit-down team rounds (4).Since the Final Rule went into effect, recent studies have evaluated the association of dialysis patient visits and outcomes. Mentari and colleagues evaluated changes in quality of care and health-related quality of life before and after the rule went into effect and found that patient visits increased from 1.5 to 3.14 (P,0.001) and the percentage of patients not seen during the month decreased from 16.6% to 5.1% (P,0.001); however, there were no differences in Kt/V, albumin, hemoglobin, phosphorus, calcium, catheter use, hospitalizations, compliance with dialysis treatment prescription, or patient satisfaction (5). Using a larger national sample of data from the US Renal Data System (USRDS), Slinin and colleagues evaluated provider-patient visit frequency and hemodialysis outcomes, and found no difference in all-cause mortality; however, patients who had four provider visits per month had a 4% lower risk of first hospitalization, or hospitalizations for...

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confidence: 75%

Geography and ESRD Care

Young

2013

Clinical Journal of the American Society of Nephrology

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“…When measuring neighborhoods, researchers most often use governmental administrative boundaries because of their convenience and the amount of data available at 16 These administrative boundaries generally represent areas larger than the conceptualization of neighborhoods, particularly when using Zip codes.…”

Section: Types Of Geospatial Informationmentioning

confidence: 99%

“…Although we discuss the integration of federal data, there also are local data available to varying degrees. Because there has been a recent overview of the methods used for linking geospatial information to kidney disease data, 16 we focus on the substantive issues regarding the importance of geospatial information.…”

Section: Types Of Geospatial Informationmentioning

confidence: 99%

“…11 Despite the growing evidence that indicates the importance of context for the major risk factors and determinants of kidney disease-cardiovascular disease, [3][4][5][6] diabetes, 9 obesity, [12][13][14] and human immunodeficiency virus (HIV) 15 -there is still a dearth of empiric research on the role of social and spatial contexts in relation to kidney disease itself, particularly at pre-end stage renal disease (ESRD) stages. 16,17 Meanwhile, research clarifying the clinical, cellular, molecular, and genetic causes of kidney disease is accelerating considerably. Although each of these stratum of information improves our overall understanding of disease, in isolation, data silos can lead to naive conclusions.…”

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confidence: 99%

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Matching the Genotype in Resolution: Innovative Ways of Phenotype Capture

Hicken¹,

Gipson²

2015

Seminars in Nephrology

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“…The way forward is likely to be anything but straightforward-but there are potential investigative and intervention tools available, including analysis of complex systems and game, or queuing, theory (19)(20)(21)(22). For instance, geospatial analysis has been used to quantify current and future health care needs in high-risk regions and identify mismatches between needs and available resources, thus informing resource allocation and policy decisions (23). Telemedicine could potentially improve access to good-quality care to otherwise isolated communities, either rural or urban-allowing effective application of evidence-based guidelines (24).…”

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confidence: 99%