More nephrologist visits to dialysis facilities not linked to better patient experience
Results from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems survey indicated that more frequent visits by nephrologists were not associated with improved patient-reported experiences.
On the contrary, researchers found a higher number of visits led to “slightly lower” care experiences.
“Recent policy initiatives to improve dialysis care — enacted as a part of the Advancing American Kidney Health (AAKH) initiative — include efforts to add flexibility for practitioners to realign priorities away from frequent visits toward high-value, patient-centered care. Early iterations of several new payment models eliminated incentives for frequent practitioner visits,” Brian M. Brady, MD, of Stanford University School of Medicine, and colleagues wrote. “In this study, we examined whether more frequent nephrology practitioner visits were associated with better patient experience with their nephrology care in outpatient hemodialysis.”
A total of 243,324 patients with Medicare Parts A/B coverage responded to the survey, which based experience on top-box scores from the Nephrologist Global Rating and the Nephrologist Communication and Caring (2,981 dialysis facilities across the United States had at least 30 surveys completed).
Of the study population, 71% had four or more visits per month, 17% had two to three visits, 4% had one visit and 8% had no visits.
While researchers observed no significant associations between nephrology practitioner visit frequency and patient-reported experience and ratings in the non-nephrologist domains, each 10% greater proportion of patients seen four or more times per month was associated with a slightly lower top-box score in the Nephrologist Global Rating measure (-0.3) and the Nephrologist Communication and Caring measure (-0.4).
According to Brady and colleagues, findings from this study mirror those from previous studies that have evaluated the impact of nephrology practitioner visit frequency on dialysis quality measures.
“For example,” the researchers wrote, “more frequent face-to-face visits in outpatient dialysis were not associated with survival, higher likelihood of kidney transplantation, or long-term survival of dialysis vascular access. This finding is also consistent with observations in other areas of health care that the intensity of health care resource use is not consistently associated with better health outcomes.”
Co-investigator Kevin Erickson, MD, MS, of Baylor College of Medicine, further commented on the findings in a related press release.
“Findings from this study provide evidence that more isn’t always better in dialysis, and that patients at facilities where physicians provide more face-to-face dialysis visits do not report better experiences with their nephrology care,” he said. “The finding that more frequent face-to-face visits are not associated with better patient-reported experiences suggests an opportunity for nephrologists to improve the care they deliver by focusing more of their time and effort toward activities that patients benefit from rather than focusing on seeing all patients four times per month.”