Estimating the effect of dialysis staffing ratio regulations on mortality and hospitalizations for Medicare hemodialysis patients

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Allan Jacob, Conor Norris, Edward Timmons
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Abstract

Background and Objectives

Eight states and Washington, DC have implemented regulations mandating a minimum ratio between treatment staff and patients receiving hemodialysis in a facility in an effort to improve the quality of hemodialysis treatment. Our investigation examines the association between minimum staffing regulations and patient mortality for four states and hospitalizations for two states that implemented these rules during our sample period.

Design, Setting, Participants, and Measurements

We utilized a synthetic difference in differences estimation to analyze the effect of minimum staffing ratios on hemodialysis treatment quality, measured by deaths and hospitalizations for end-stage renal disease patients. We used data gathered by the US Renal Data System and aggregated at the state level.

Results

We are unable to find evidence that mandated dialysis staffing ratios area associated with a reduction in mortality or hospitalizations. We estimate a slight reduction in deaths per 1000 patient hours and a slight increase in hospitalizations, but neither are statistically significant.

Conclusions

We were unable to find evidence that minimum staffing ratios for hemodialysis facilities are associated with improved patient outcomes. Our findings highlight the need for future work, studying the impact of these regulations at the facility level.

Abstract Image

评估透析人员配置比例规定对医疗保险血液透析患者死亡率和住院率的影响。
背景和目标:为了提高血液透析治疗的质量,八个州和华盛顿特区已经实施了规定,要求治疗人员和接受血液透析的患者之间的最低比例。我们的调查考察了四个州的最低人员配备规定与患者死亡率之间的关系,以及在我们的样本期内实施这些规定的两个州的住院人数之间的关系。设计、设置、参与者和测量:我们利用差异中的综合差异估计来分析最低人员配置比率对血液透析治疗质量的影响,通过终末期肾病患者的死亡和住院来衡量。我们使用了美国肾脏数据系统收集的数据,并在州一级进行了汇总。结果:我们无法找到证据表明强制透析人员配备比例与死亡率或住院率的降低有关。我们估计每1000名患者小时的死亡人数略有减少,住院人数略有增加,但两者都没有统计学意义。结论:我们无法找到证据表明血液透析设施的最低人员配置比例与患者预后的改善有关。我们的研究结果强调了未来工作的必要性,研究这些法规在设施层面的影响。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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