Joel T. Adler, MD, MPH Department of Surgery, Brigham and Women’s Hospital Center for Surgery and Public Health Brigham and Women’s Hospital Boston, Massachusetts

More Transplantation Referrals from Higher Quality Dialysis Centers

MedicalResearch.com Interview with:

Joel T. Adler, MD, MPH Department of Surgery, Brigham and Women’s Hospital Center for Surgery and Public Health Brigham and Women’s Hospital Boston, Massachusetts

Dr. Adler

Joel T. Adler, MD, MPH
Department of Surgery, Brigham and Women’s Hospital
Center for Surgery and Public Health
Brigham and Women’s Hospital
Boston, Massachusetts 

MedicalResearch.com: What is the background for this study?

Response: For patients who require renal replacement therapy for failed kidneys, kidney transplantation increased length of life and improves quality of life.  For many of these patients, their dialysis centers are the source of referral for evaluation for transplantation.  These dialysis centers have a number of publicly-reported quality measures, but they largely focus on the provision of dialysis care and not how often the centers’ patients undergo a kidney transplant.  Because these higher-rated facilities provide better dialysis care, we wanted to know if that benefit also spilled over into higher transplant listing rates.

MedicalResearch.com: What are the main findings? Did you find racial or ethnic disparities in transplantation referrals?

Response: Within 1 year of beginning dialysis, we found that patients at five star (higher quality) dialysis facilities were 47% more likely to be listed for kidney transplantation than those at one star (lower quality) facilities.  After adjusting for other measures of quality and access to care, we also found that Black patients remained 26% less likely to be listed for transplantation compared to White patients.  Most importantly, Black and Hispanic patients were also more likely to be at lower quality dialysis facilities, which appears to worsen their access to care. 

MedicalResearch.com: What should readers take away from your report?

Response: Patients at a higher-quality dialysis facility were more likely to be listed for kidney transplantation.  Integrating measures of transplant access into dialysis facility quality metrics could be a useful policy mechanism to increase dialysis facility referral to transplant centers.  Moreover, patients could also use this information to help choose their dialysis facilities to maximize their chances at kidney transplantation.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: For the future, there needs to be further attention to the relationship between dialysis facility quality and how this impacts the patient experience in access to transplantation.  Also, testing different methods of an all-encompassing quality metric for dialysis centers to integrate both clinical outcomes and access to transplantation, and how this can improve both patient and provider experiences.

Any disclosures?

Funding for this study was provided by the 2020 American Society of Transplant Surgeons-CareDx Enhancing Organ Donation and Transplantation grant. 

Citation:

Adler JT, Xiang L, Weissman JS, et al. Association of Public Reporting of Medicare Dialysis Facility Quality Ratings With Access to Kidney Transplantation. JAMA Netw Open. 2021;4(9):e2126719. doi:10.1001/jamanetworkopen.2021.26719

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Sep 27, 2021 @ 10:00 pm

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