■医疗保险和医疗补助服务中心强制性终末期肾病治疗选择(ETC)模式,2021年1月1日启动,随机分配了大约30%的美国透析设施和管理临床医生接受财政激励,以增加家庭透析和肾脏移植的使用.
为了评估ETC与在模型的头2年中使用家庭透析和肾脏移植的关联,并根据种族检查这些结果的变化,种族,和社会经济地位。
这项回顾性横断面研究使用了2017年至2022年传统的肾衰竭医疗保险受益人的索赔和登记数据,与来自器官共享联合网络的同期移植数据相关联。研究数据跨度为2021年1月1日ETC模型实施前4年(2017-2020年),模型实施后2年(2021-2022年)。
■在随机分配到ETC模型的区域中接受透析治疗。
■主要结果是使用家庭透析和肾移植。使用差异差异(DiD)方法来估计在随机选择参加ETC的区域中接受治疗的患者的结果变化,与在对照组中接受治疗的患者的同时变化相比。
■研究人群包括724406名肾衰竭患者(平均[IQR]年龄,62.2[53-72]岁;42.5%为女性)。ETC地区接受家庭透析的患者比例由12.1%上升至14.3%,对照组由12.9%上升至15.1%,得出调整后的DID估计值为-0.2个百分点(pp;95%CI,-0.7至0.3pp)。移植的类似分析产生0.02pp(95%CI,-0.01至0.04pp)的调整后的DiD估计。当通过社会人口统计学指标进一步分层时,包括年龄,性别,种族和民族,双重医疗保险和医疗补助登记,和贫困四分位数,不同特征和ETC参与的家庭透析使用差异无统计学意义.
■在这项横断面研究中,ETC模型的前2年与家庭透析或肾脏移植的使用增加无关,也没有种族的变化,民族,以及这些结果中的社会经济差异。
UNASSIGNED: The Centers for
Medicare & Medicaid Services\' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.
UNASSIGNED: To assess the ETC\'s association with use of home dialysis and kidney transplant during the model\'s first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status.
UNASSIGNED: This retrospective cross-sectional study used claims and enrollment data for traditional
Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model\'s implementation.
UNASSIGNED: Receiving dialysis treatment in a region randomly assigned to the ETC model.
UNASSIGNED: Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions.
UNASSIGNED: The study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of -0.2 percentage points (pp; 95% CI, -0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, -0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual
Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation.
UNASSIGNED: In this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.