142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Geographic Determinants of Access to Peritoneal Dialysis

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 1:10 PM - 1:30 PM

Marc Turenne, PhD , Arbor Research Collaborative for Health, Ann Arbor, MI
Jeffrey Pearson, MS , Arbor Research Collaborative for Health, Ann Arbor, MI
Chad Cogan, MS , Arbor Research Collaborative for Health, Ann Arbor, MI
Purna Mukhopadhyay, PhD , Arbor Research Collaborative for Health, Ann Arbor, MI
Elizabeth Cope, PhD , Arbor Research Collaborative for Health, Ann Arbor, MI
Dialysis treatment for end-stage renal disease is most often provided through thrice-weekly hemodialysis (HD) at outpatient clinics. Home-based therapy is generally less costly than HD and has potential advantages due to clinical, employment-related, or other factors. However, the fraction of patients using peritoneal dialysis (PD), the dominant home dialysis therapy, declined from 14% in 1990 to 6% in 2009, which is much lower compared to many other countries. Recent Medicare payment reform was expected to incentivize PD. We hypothesize that access to clinics offering PD is one factor that may limit PD use, and may have improved following the recent reform. Using national Medicare data from 2009-2012, we examined modality at dialysis incidence and the distance between zip code centroids for patient residence (n=421,047 patients) and nearby clinics. On average, pre-reform incident patients (2009-10) resided closer to clinics offering HD (3.9 miles) than PD (7.7 miles). Post-reform (2011-12) distances were somewhat lower (3.7 and 7.4 miles for HD and PD, respectively). In 2009-10, patients in metropolitan areas had low differential distance (mean 1.7 miles farther for the nearest PD vs. HD clinic) compared to patients in micropolitan areas (mean 11.7 miles) and small town/rural areas (mean 12.5 miles). However, a significant post-reform increase in clinics offering PD, especially in rural areas, did not substantially reduce the differential distance  either overall (from 3.8 miles in 2009-10 to 3.7 miles in 2011-12) or by urbanicity. In metropolitan areas, PD use was lowest and did not vary by differential distance. PD use was higher in non-metropolitan areas and varied by differential distance in non-metropolitan areas in both time periods, potentially indicating continued opportunities for improved access despite early effects of the reform.

Learning Areas:

Biostatistics, economics
Chronic disease management and prevention
Public health or related public policy
Public health or related research

Learning Objectives:
Describe geographic factors associated with patient access to home-based peritoneal dialysis before and after the recent Medicare end-stage renal disease payment reform.

Keyword(s): Health Care Access, Medicare

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principle investigator of multiple federally funded projects, one of them focused on studying health Care Disparities in End-Stage Renal Disease. The purpose of the study is to evaluate changes in access to care, clinical processes of care, and clinical outcomes among Medicare beneficiaries with ESRD; how health disparity populations were affected by the recent Medicare ESRD payment reform.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.