Abstract
BackgroundThe choice of vascular access type is an important aspect of care for incident hemodialysis patients. However, data from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (form CMS-2728) identifying the first access for incident patients have not previously been validated. Medicare began requiring that vascular access type be reported on claims in July 2010. We aimed to determine the agreement between the reported vascular access at initiation from form CMS-2728 and from Medicare claims.MethodsThis retrospective study used a cohort of 9777 patients who initiated dialysis in the latter half of 2010 and were eligible for Medicare at the start of renal replacement therapy to compare the vascular access type reported on form CMS-2728 with the type reported on Medicare outpatient dialysis claims for the same patients. For each patient, the reported access from each data source was compiled; the percent agreement represented the percent of patients for whom the access was the same. Multivariate logistic analysis was performed to identify characteristics associated with the agreement of reported access.ResultsThe two data sources agreed for 94% of patients, with a Kappa statistic of 0.83, indicating an excellent level of agreement. Further, we found no evidence to suggest that agreement was associated with the patient characteristics of age, sex, race, or primary cause of renal failure.ConclusionThese results suggest that vascular access data as reported on form CMS-2728 are valid and reliable for use in research studies.
Highlights
The choice of vascular access type is an important aspect of care for incident hemodialysis patients
It is generally accepted that long-term use of catheters can cause vein stenosis [1,2], and catheters are associated with adverse outcomes such as infections and complications [3], compared with arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs)
Patients To ensure the presence of Medicare outpatient dialysis claims at hemodialysis initiation, only patients who were eligible for Medicare before end-stage renal disease (ESRD) onset were considered
Summary
The choice of vascular access type is an important aspect of care for incident hemodialysis patients. Data from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (form CMS-2728) identifying the first access for incident patients have not previously been validated. We aimed to determine the agreement between the reported vascular access at initiation from form CMS-2728 and from Medicare claims. In 2005, the Centers for Medicare & Medicaid Services (CMS) revised the end-stage renal disease (ESRD) Medical Evidence Report (form CMS-2728) to collect information regarding the type of access used at the first outpatient dialysis session for incident patients. Beginning in July 2010, outpatient dialysis facilities were required to report the type of vascular access used for dialysis on claims submitted to Medicare for payment. The purpose of this study was to determine the agreement between the reported vascular access at initiation from these two data sources
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