Disclosures: Disclosures: Dr. Erickson provides consulting services for Acumen LLC. Please see the manuscript for disclosures of other authors.
October 14, 2021
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Dialysis facility closures linked to higher patient hospitalizations and deaths

Disclosures: Disclosures: Dr. Erickson provides consulting services for Acumen LLC. Please see the manuscript for disclosures of other authors.
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Dialysis patients displaced after a facility closure experienced higher rates of hospitalization and death compared with patients in facilities that did not close, a new study shows.

A team led by Kevin Erickson, MD, MS, examined dialysis facility closures between 2001 and 2014 to assess the effects of closures on patient health outcomes. The researchers identified 8,386 patients affected by 521 dialysis facility closures. “In different models, patients who were affected by dialysis facility closures experienced 7% to 9% higher rates of hospitalizations compared with similar patients at facilities that did not close,” according to a press release on the results of the study. “Also, patients affected by closures may have faced an 8% higher risk of dying within 6 months.

“Ongoing efforts to contain high costs of in-center hemodialysis, including recent national policy reforms, could increase the risk that some dialysis facilities will close,” Erickson, of the division of nephrology at Baylor College of Medicine, said in the release. “It is important to understand how dialysis facility closures impact the health of patients. We previously demonstrated that hospital-based dialysis facilities, which disproportionately care for vulnerable patient populations, are at increased risk of closures. Facility closures could exacerbate inequities in U.S. dialysis care.”

In an interview with Healio Nephrology, Erickson said the study did not look at the rate of facility closures by ownership. “The goal of this study was to understand how dialysis facility closures affect patient health outcomes. We did this in models that used propensity and facility matching,” Erickson said. “Because of this matching process, our cohort of patients and dialysis facilities did not provide information about risk factors for closures.

“We did, however, look at this topic in an earlier study of dialysis facility closures,” Erickson continued. “In that study, we found that smaller dialysis facilities, for-profit facilities and hospital-based facilities were more likely to be affected by closures between 2006 and 2015. In that study, we also found that chain-owned facilities and facilities in small towns and rural areas were less likely to be affected by closures.”

Kevin Erickson

In secondary analyses of the data, Erickson and colleagues wrote they found that “patients transitioning to a facility within the same chain had more hospitalizations following closures when compared with those who transferred to a facility with a different owner. Although this difference did not reach statistical significance, it suggests that patients may not benefit from the continuity associated with remaining within the same chain.”

Erickson told Healio Nephrology, “We had expected to find that the dialysis facility closures would be less associated with negative health outcomes when patients stayed in the same chain. This is because these patients may have more care continuity, such as keeping the same EMR.

“Instead, we found the opposite,” he said. “Hospitalizations were more common after closures when patients stayed in the same chain. It is important to note that this finding was not statistically significant and that it is from one of several additional analyses that we conducted looking at different facility characteristics.

“As we discuss in the paper, our main take away from the additional analyses of dialysis facility characteristics is that the effects of closures may vary across facility types,” Erickson told Healio Nephrology. “If dialysis facility closures become more common in the future, it will be important to understand whether patients at different types of facilities are, in fact, differentially affected by closures, and if so, why.”

As part of that secondary analyses, the researchers also found that patients in the facility-matched comparison group were more likely to die following a closure if they left a hospital-based facility when compared with those who left free-standing facilities. “Together, these findings suggest that the effects of closures vary across different dialysis facilities and that it will be important to better understand the ways in which the organizational characteristics of the facility where patients transition out of and into influence health outcomes following a facility closure,” Erickson said.