Hemodialysis Patient Outcomes: Provider Characteristics

Background/Aims: Physician characteristics are associated with differential performance on quality measures and patient outcomes in several medical fields. We aimed to determine whether characteristics of physicians who provide care to dialysis patients were associated with patient outcomes. Methods: This cohort study used United States Renal Data System data for patients who initiated in-center hemodialysis between October 1, 2003, and September 30, 2006 (n = 91,276). Patient characteristics were defined and physicians identified from Part B Medicare claims for outpatient dialysis services submitted during months 4–6 of hemodialysis. Physician characteristics were obtained from the American Medical Association Physician Master File. Associations of physician characteristics with 1-year patient mortality and first hospitalization were determined using Cox proportional hazards analysis; associations with quality of care (defined by influenza vaccination and waitlisting for kidney transplant) were determined using logistic regression. Results: Physician characteristics were not associated with patient mortality. After adjustment for patient and other provider characteristics, patients whose physicians had practiced longer or were in administrative, research, or teaching practices were more likely to be hospitalized; patients whose providPublished online: April 23, 2014 Nephrology American Journal of Yelena Slinin, MD, MS VA Medical Center (111J) One Veteran’s Drive Minneapolis, MN 55417 (USA) E-Mail slini001 @ umn.edu © 2014 S. Karger AG, Basel 0250–8095/14/0395–0367$39.50/0