Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Jan;9(1):73-81.
doi: 10.2215/CJN.04200413. Epub 2013 Dec 26.

Comparison of hospitalization rates among for-profit and nonprofit dialysis facilities

Lorien S Dalrymple  1 , Kirsten L Johansen, Patrick S Romano, Glenn M Chertow, Yi Mu, Julie H Ishida, Barbara Grimes, George A Kaysen, Danh V Nguyen
Affiliations
Comparative Study

Comparison of hospitalization rates among for-profit and nonprofit dialysis facilities

Lorien S Dalrymple et al. Clin J Am Soc Nephrol. 2014 Jan.

Abstract

Background and objectives: The vast majority of US dialysis facilities are for-profit and profit status has been associated with processes of care and outcomes in patients on dialysis. This study examined whether dialysis facility profit status was associated with the rate of hospitalization in patients starting dialysis.

Design, setting, participants, & methods: This was a retrospective cohort study of Medicare beneficiaries starting dialysis between 2005 and 2008 using data from the US Renal Data System. All-cause hospitalization was examined and compared between for-profit and nonprofit dialysis facilities through 2009 using Poisson regression. Companion analyses of cause-specific hospitalization that are likely to be influenced by dialysis facility practices including hospitalizations for heart failure and volume overload, access complications, or hyperkalemia were conducted.

Results: The cohort included 150,642 patients. Of these, 12,985 (9%) were receiving care in nonprofit dialysis facilities. In adjusted models, patients receiving hemodialysis in for-profit facilities had a 15% (95% confidence interval [95% CI], 13% to 18%) higher relative rate of hospitalization compared with those in nonprofit facilities. Among patients receiving peritoneal dialysis, the rate of hospitalization in for-profit versus nonprofit facilities was not significantly different (relative rate, 1.07; 95% CI, 0.97 to 1.17). Patients on hemodialysis receiving care in for-profit dialysis facilities had a 37% (95% CI, 31% to 44%) higher rate of hospitalization for heart failure or volume overload and a 15% (95% CI, 11% to 20%) higher rate of hospitalization for vascular access complications.

Conclusions: Hospitalization rates were significantly higher for patients receiving hemodialysis in for-profit compared with nonprofit dialysis facilities.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Cohort selection. The figure shows inclusion and exclusion criteria and selection of the cohort. CMS, Centers for Medicare and Medicaid Services.
See this image and copyright information in PMC

Comment in

References

    1. Rosenau PV, Linder SH: Two decades of research comparing for-profit and nonprofit health provider performance in the United States. Soc Sci Q 84: 219–241, 2003
    1. Medical Payment Advisory Commission (MedPAC): Outpatient Dialysis Services. Report to the Congress: Medicare Payment Policy, Washington, DC, MedPAC, 2012
    1. Devereaux PJ, Schünemann HJ, Ravindran N, Bhandari M, Garg AX, Choi PT, Grant BJ, Haines T, Lacchetti C, Weaver B, Lavis JN, Cook DJ, Haslam DR, Sullivan T, Guyatt GH: Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: A systematic review and meta-analysis. JAMA 288: 2449–2457, 2002 - PubMed
    1. Zhang Y, Cotter DJ, Thamer M: The effect of dialysis chains on mortality among patients receiving hemodialysis. Health Serv Res 46: 747–767, 2011 - PMC - PubMed
    1. US Renal Data System : USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2012

Publication types

MeSH terms