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. 2021 Jun;78(3):281-290.
doi: 10.1177/1077558720910633. Epub 2020 Mar 6.

Trends in Regional Supply of Peritoneal Dialysis in an Era of Health Reform, 2006 to 2013

Caroline E Sloan  1   2 , Cynthia J Coffman  1   2 , Linda L Sanders  1   2 , Matthew L Maciejewski  1   2 , Shoou-Yih D Lee  3 , Richard A Hirth  3 , Virginia Wang  1   2
Affiliations

Trends in Regional Supply of Peritoneal Dialysis in an Era of Health Reform, 2006 to 2013

Caroline E Sloan et al. Med Care Res Rev. 2021 Jun.

Abstract

Peritoneal dialysis (PD), a home-based treatment for kidney failure, is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis. Yet <10% of patients receive PD. Access to this alternative treatment, vis-à-vis providers' supply of PD services, may be an important factor but has been sparsely studied in the current era of national payment reform for dialysis care. We describe temporal and regional variation in PD supply among Medicare-certified dialysis facilities from 2006 to 2013. The average proportion of facilities offering PD per hospital referral region increased from 40% (2006) to 43% (2013). PD supply was highest in hospital referral regions with higher percentage of facilities in urban areas (p = .004), prevalence of PD use (p < .0001), percentage of White end-stage renal disease patients (p = .02), and per capita income (p = .02). Disparities in PD access persist in rural, non-White, and low-income regions. Policy efforts to further increase regional PD supply should focus on these underserved communities.

Keywords: access to care; end-stage renal disease; hospital referral regions; peritoneal dialysis.

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Conflict of interest statement

Conflicts of interest: Dr. Maciejewski reports ownership of Amgen stock due to his spouse’s employment. The other authors (CS, CJC, LLS, SYDL, RH, and VW) report no relationship or financial interest with any entity that would pose a conflict of interest regarding the subject matter of this article.

Figures

Figure 1.
Figure 1.. Regional patterns of PD Provision in US Dialysis Facilities, 2006–2013.
A. Proportion of facilities offering peritoneal dialysis in each hospital referral region in 2006. Star: Rapid City, South Dakota HRR Circle: Lynchburg, Virginia HRR Square: San Francisco, California HRR Triangle: Hartford, Connecticut HRR B. Change in proportion of facilities offering peritoneal dialysis in each hospital referral region between 2006 and 2013. Star: Rapid City, South Dakota HRR Circle: Lynchburg, Virginia HRR Square: San Francisco, California HRR Triangle: Hartford, Connecticut HRR
Figure 1.
Figure 1.. Regional patterns of PD Provision in US Dialysis Facilities, 2006–2013.
A. Proportion of facilities offering peritoneal dialysis in each hospital referral region in 2006. Star: Rapid City, South Dakota HRR Circle: Lynchburg, Virginia HRR Square: San Francisco, California HRR Triangle: Hartford, Connecticut HRR B. Change in proportion of facilities offering peritoneal dialysis in each hospital referral region between 2006 and 2013. Star: Rapid City, South Dakota HRR Circle: Lynchburg, Virginia HRR Square: San Francisco, California HRR Triangle: Hartford, Connecticut HRR
Figure 2.
Figure 2.. The percentage of facilities offering PD in predominantly rural regions increased, but did not catch up to levels in predominantly urban regions.
This figure represents the penalized B-spline trajectories of regional PD supply, stratified by urban zip code category. Each category contains roughly the same number of HRRs: 103–108 HRRs had 0–55% urban zip codes, 97–103 HRRs had 56–85% urban zip codes, and 99–105 HRRs had 86–100% urban zip codes. The number of HRRs in each group varied slightly by year, as some zip codes that were initially rural came to be defined as urban, and vice versa.
See this image and copyright information in PMC

References

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    1. Centers for Medicare & Medicaid Services. 2018. End Stage Renal Disease (ESRD) Prospective Payment System (PPS). Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpaymen... (accessed August 8, 2018). Baltimore, MD.
    1. Centers for Medicare & Medicaid Services. 2019. Medicare Program: Specialty Care Models To Improve Quality of Care and Reduce Expenditures (Proposed Rule CMS-5527-P). In Docket number CMS-2019–0101, edited by C. f. M. a. M. S. Department of Health and Human Services. Washington, DC: Federal Register.

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