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
. 2021 Feb;56(1):123-131.
doi: 10.1111/1475-6773.13600. Epub 2020 Nov 12.

Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare

Stephen Salerno  1 , Claudia Dahlerus  1 , Joseph Messana  1 , Karen Wisniewski  1 , Lan Tong  1 , Richard A Hirth  1 , Jordan Affholter  1 , Garrett Gremel  1 , YiFan Wu  1 , Ji Zhu  1 , Jesse Roach  2 , Elena Balovlenkov Rn  2 , Joel Andress  2 , Yi Li  1
Affiliations

Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare

Stephen Salerno et al. Health Serv Res. 2021 Feb.

Abstract

Objective: To examine which factors are driving improvement in the Dialysis Facility Compare (DFC) star ratings and to test whether nonclinical facility characteristics are associated with observed longitudinal changes in the star ratings.

Data sources: Data were collected from eligible patients in over 6,000 Medicare-certified dialysis facilities from three annual star rating and individual measure updates, publicly released on DFC in October 2015, October 2016, and April 2018.

Study design: Changes in the star rating and individual quality measures were investigated across three public data releases. Year-to-year changes in the star ratings were linked to facility characteristics, adjusting for baseline differences in quality measure performance.

Data collection: Data from publicly reported quality measures, including standardized mortality, hospitalization, and transfusion ratios, dialysis adequacy, type of vascular access for dialysis, and management of mineral and bone disease, were extracted from annual DFC data releases.

Principal findings: The proportion of four- and five-star facilities increased from 30.0% to 53.4% between October 2015 and April 2018. Quality improvement was driven by the domain of care containing the dialysis adequacy and hypercalcemia measures. Additionally, independently owned facilities and facilities belonging to smaller dialysis organizations had significantly lower odds of year-to-year improvement than facilities belonging to either of the two large dialysis organizations (Odds Ratio [OR]: 0.736, 95% Confidence Interval [CI]: 0.631-0.856 and OR: 0.797, 95% CI: 0.723-0.879, respectively).

Conclusions: The percentage of four- and five-star facilities has increased markedly over a three-year time period. These changes were driven by improvement in the specific quality measures that may be most directly under the control of the dialysis facility.

Keywords: dialysis; medicare; public reporting; quality measures; star ratings.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Distribution of the Dialysis Facility Compare Star Rating by data release year
Figure 2
Figure 2
Trends in clinical measure values and standardized scores over time. (A) Mean measure values for the individual clinical quality measures used in calculating the Dialysis Facility Compare Star Rating; (B) their corresponding domain‐averaged measure sores; and (C) the resulting average final scores, stratified by chain affiliation
See this image and copyright information in PMC

References

    1. Frederick PR, Maxey NL, Clauser SB, Sugarman JR. Developing dialysis facility‐specific performance measures for public reporting. Health Care Financ Rev. 2002;23(4):37–50. - PMC - PubMed
    1. Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers. In: Office USGA, ed. Vol GAO‐15‐11. Washington DC: October 2014.
    1. Gerteis M, Thomas C, Blatt L, et al. Quality Reporting on Medicare's Compare Sites: Lessons Learned from Consumer Research, 2001–2014. Princeton: Mathematica Policy Research; 2015.
    1. University of Michigan Kidney Epidemiology and Cost Center . Technical Notes on the Updated Dialysis Facility Compare Star Rating Methodology. 2016. https://dialysisdata.org/sites/default/files/content/Methodology/Updated.... Accessed August 24, 2018.
    1. Ratcliffe MR. Creating metropolitan and micropolitan statistical areas. Measuring Rural Diversity. 2006;3(1):1–13. Accessed August 24, 2018

Publication types