the effect of dialysis chains on mortality among patients receiving hemodialysis
yi zhang, dennis j. cotter, and mae thamer . health research and educational trust
...although patients in chain 5 were slightly younger than patients from other facilities, they also had clinical factors that have been shown to be associated with decreased survival, such as lower serum albumin, higher serum creatinine, lower predialysis hct, and the highest charlson index scores. compared with patients in chain 2 who had the highest risk of mortality, patients in chain 5 also had similar preexisting comorbid conditions.
patients from chain 2 had the highest risk of mortality and the difference in the mortality risks between chain 2 and chain 5 (which had the lowest mortality) was found to be 24 percent.
some contend that lower resource use in the delivery of dialysis by fp facilities compromises the health outcomes of dialysis patients. fp facilities use less labor and equipment per treatment, for instance, suggesting a lower average cost per dialysis session (grifﬁths et al. 1994). poor outcomes might also be attributable to lower levels of stafﬁng in fp facilities (held et al. 1990), which notably affects esrd patients who rely on their dialysis center as their primary health care provider (holley and nespor 1993; bender and holley 1996).
given the organizational status of a facility was found to be strongly associated with the use of injectables and use of higher drug doses did not improve patient survival, the current study might have important implications
regarding the wisdom of bundling separately billable items (primarily injectable medications) with other composite rate services into the new dialysis prospective payment system to be implemented in january 2011. our ﬁndings--that lower doses of injectable drugs do not appear to compromise quality of care--supports medicare's implementation of a bundled payment system for injectable drugs.
i've read the article twice now and the only discussion i can come up with is: yikes! 24% !