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Abstract
The Centers for Medicare and Medicaid Services recently released a five star rating system as part of ‘Dialysis Facility Compare’ to help patients identify and choose high performing clinics in the US. Eight dialysis-related measures determine ratings. Little is known about the association between surrounding community sociodemographic characteristics and star ratings. Using data from the U.S. Census and over 6000 dialysis clinics across the country, we examined the association between dialysis clinic star ratings and characteristics of the local population: 1) proportion of population below the federal poverty level (FPL); 2) proportion of black individuals; and 3) proportion of Hispanic individuals, by correlation and regression analyses. Secondary analyses with Quality Incentive Program (QIP) scores and population characteristics were also performed. We observed a negligible correlation between star ratings and the proportion of local individuals below FPL; Spearman coefficient, R = -0.09 (p<0.0001), and a stronger correlation between star ratings and the proportion of black individuals; R = -0.21 (p<0.0001). Ordered logistic regression analyses yielded adjusted odds ratio of 0.91 (95% confidence interval [0.80–1.30], p = 0.12) and 0.55 ([0.48–0.63], p<0.0001) for high vs. low level of proportion below FPL and proportion of black individuals, respectively. In contrast, a near-zero correlation was observed between star ratings and the proportion of Hispanic individuals. Correlations varied substantially by country region, clinic profit status and clinic size. Analyses using clinic QIP scores provided similar results. Sociodemographic characteristics of the surrounding community, factors typically outside of providers’ direct control, have varying levels of association with clinic dialysis star ratings.
Highlights
In 2014, the Centers for Medicare and Medicaid Services (CMS) introduced a Five-Star Quality Rating System as part of Dialysis Facility Compare (DFC) to help inform patients and caregivers in choosing a dialysis clinic in the United States (US)
We examined the association of area-level poverty and other local population characteristics with dialysis clinic star ratings
Data for 6,032 dialysis clinics were available for analysis
Summary
In 2014, the Centers for Medicare and Medicaid Services (CMS) introduced a Five-Star Quality Rating System as part of Dialysis Facility Compare (DFC) to help inform patients and caregivers in choosing a dialysis clinic in the United States (US). Released to the public in 2015 and updated in 2016, DFC uses a composite score generated from 8 individual clinical measures to quantify quality on a scale of 1 to 5 stars [1]: (1) standardized mortality ratio; (2) standardized transfusion ratio; (3) standardized hospitalization ratio; (4) adequate waste removal for hemodialysis; (5) adequate waste removal for peritoneal dialysis; (6) hypercalcemia; (7) percentage fistula; and (8) percentage catheters used >90 days. These measures are similar to those included in the more established End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) [2]. There has been no assessment of the association of characteristics of the community surrounding dialysis clinics and dialysis clinic star rating scores
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