What is the best setting for receiving dialysis vascular access repair and maintenance services?

J Vasc Access. 2017 Nov 17;18(6):473-481. doi: 10.5301/jva.5000790. Epub 2017 Sep 2.


Introduction: Advances in dialysis vascular access (DVA) management have changed where beneficiaries receive this care. The effectiveness, safety, quality, and economy of different care settings have been questioned. This study compares patient outcomes of receiving DVA services in the freestanding office-based center (FOC) to those of the hospital outpatient department (HOPD). It also examines whether outcomes differ for a centrally managed system of FOCs (CMFOC) compared to all other FOCs (AOFOC).

Methods: Retrospective cohort study of clinically and demographically similar patients within Medicare claims available through United States Renal Data System (USRDS) (2010-2013) who received at least 80% of DVA services in an FOC (n = 80,831) or HOPD (n = 133,965). Separately, FOC population is divided into CMFOC (n = 20,802) and AOFOC (n = 80,267). Propensity matching was used to control for clinical, demographic, and functional characteristics across populations.

Results: FOC patients experienced significantly better outcomes, including lower annual mortality (14.6% vs. 17.2%, p<0.001) and DVA-related infections (0.16 vs. 0.20, p<0.001), fewer hospitalizations (1.65 vs. 1.91, p<0.001), and lower total per-member-per-month (PMPM) payments ($5042 vs. $5361, p<0.001) than HOPD patients. CMFOC patients had lower annual mortality (12.5% vs. 13.8%, p<0.001), PMPM payments (DVA services) ($1486 vs. $1533, p<0.001) and hospitalizations ($1752 vs. $1816, p<0.001) than AOFOC patients.

Conclusions: Where nephrologists send patients for DVA services can impact patient clinical and economic outcomes. This research confirmed that patients who received DVA care in the FOC had better outcomes than those treated in the HOPD. The organizational culture and clinical oversight of the CMFOC may result in more favorable outcomes than receiving care in AOFOC.

Publication types

  • Comparative Study

MeSH terms

  • Administrative Claims, Healthcare
  • Ambulatory Care Facilities* / economics
  • Arteriovenous Shunt, Surgical* / adverse effects
  • Arteriovenous Shunt, Surgical* / economics
  • Arteriovenous Shunt, Surgical* / mortality
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / economics
  • Blood Vessel Prosthesis Implantation* / mortality
  • Catheterization, Central Venous* / adverse effects
  • Catheterization, Central Venous* / economics
  • Catheterization, Central Venous* / mortality
  • Centralized Hospital Services
  • Cost-Benefit Analysis
  • Databases, Factual
  • Delivery of Health Care, Integrated* / economics
  • Female
  • Healthcare Disparities
  • Hospital Costs
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Office Visits
  • Outpatient Clinics, Hospital* / economics
  • Patient Admission
  • Postoperative Complications / therapy
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / economics
  • Renal Dialysis* / mortality
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • United States
  • Vascular Patency