Regional variation in health care intensity and treatment practices for end-stage renal disease in older adults.

JAMA : the Journal of the American Medical Association
Ann M O'HareManjula Kurella Tamura

Abstract

An increasing number of older adults are being treated for end-stage renal disease (ESRD) with long-term dialysis. To determine how ESRD treatment practices for older adults vary across regions with differing end-of-life intensity of care. Retrospective observational study using a national ESRD registry to identify a cohort of 41,420 adults (of white or black race), aged 65 years or older, who started long-term dialysis or received a kidney transplant between June 1, 2005, and May 31, 2006. Regional end-of-life intensity of care was defined using an index from the Dartmouth Atlas of Healthcare. Incidence of treated ESRD (dialysis or transplant), preparedness for ESRD (under the care of a nephrologist, having a fistula [vs graft or catheter] at time of hemodialysis initiation), and end-of-life care practices. Among whites, the incidence of ESRD was progressively higher in regions with greater intensity of care and this trend was most pronounced at older ages. Among blacks, a similar relationship was present only at advanced ages (men aged > or = 80 years and women aged > or = 85 years). Patients living in regions in the highest compared with lowest quintile of end-of-life intensity of care were less likely to be under the care o...Continue Reading

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