Lower patient satisfaction reported at for-profit dialysis centers

1. Patient reported experience has recently been incorporated into Quality Incentive Programs for dialysis centers across the United States. Lower patient experience scores were reported in for-profit, free-standing, and large dialysis organization centers.

2. Centers with higher proportion of black and Native American patients had lower patient reported experience scores.

Evidence Rating Level: 3 (Average)      

Study Rundown: Efforts to place patient experience at the forefront of medical care have lead to increased utilization of patient-reported experiences in calculations for reimbursement in Quality Incentive Programs (QIP). The national funding for dialysis in End-Stage Renal Disease through Medicare allows for the evaluation of strategies to incorporate patient-centered outcomes in reimbursement programs. This study reported the outcomes of patient reported experiences in dialysis centers and the association between socioeconomic and dialysis site-specific factors. Patient experiences were lower-rated in centers that were for-profit, owned by large dialysis organizations, or located in free-standing rather than hospital associated structures. Centers with high proportions of black and Native American patients also had lower patient-reported experiences.

Patient reported outcomes are increasingly becoming better integrated into systems design to ensure quality of care. The main strengths of the study included the standardized survey used across the nation leading to a large population being assessed with a consistent method. The main limitations of the study include the lack of data on clinical outcomes, and the large proportion of patients treated at small centers who did not complete the patient experience survey.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Measuring patient experience in dialysis: a new paradigm of quality assessment

In-Depth [cross-sectional study]: This study included results from dialysis facilities in the United States from 2015-2016. Patient reported experiences were assessed using the In Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey. Centres treating less than 30 patients were not required to complete the survey. Data on socio-economic variables was obtained using US census data linked by zip code. Medicare data was used to obtain clinical data on patient comorbidities.

The study had ICH-CAHPS data from 59.1% of centers encompassing 2939 facilities. Patient reported experiences were lower in for-profit facilities (2.6 percentage points, 95%CI, 1.5-3.7), facilities owned by large dialysis organizations (1.6 percentage points, 95%CI, 0.9-2.2), and in free-standing structures (2.3 percentage points, 95%CI, 0.5-4.2). Facilities with higher porportions of black (0.95 percentage points, 95%CI, 0.78-1.12) and Native American (1.00 percentage point, 95%CI, 0.39-1.60) patients also reported lower scores.

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